Long-Term Results of Laparoscopic Retroperitoneal Lymph-Node Dissection for Clinical Stage I Nonseminomatous Germ-Cell Testicular Cancer

Neyer, Michael; Peschel, Reinhard; Akkad, Thomas; Springer-Stöhr, Brigette; Berger, Andreas; Bartsch, Georg; Steiner, Hannes

doi:10.1089/end.2006.0233

Cited by 59 publications

(41 citation statements)

References 28 publications

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“…18, 19 The role of open RPLND in the management of testicular cancer is now established, 20 with laparoscopic RPLND also being performed for smaller masses. 16,18,20,21 Up to 50% of patients with a radiological stage 1 tumour and histological evidence of vascular invasion may have retroperitoneal lymph node involvement. 13 Primary RPLND is an established treatment in some centres in the US.…”

Section: Discussionmentioning

confidence: 99%

“…23,24,[27][28][29] Laparoscopic RPLND has been described in the treatment of patients with testicular tumours. 21,30,31 Primary laparoscopic RPLND for low stage testicular tumours has shown to have reduced morbidity compared with the open technique. 21,[30][31][32] However, post-chemotherapy laparoscopic RPLND is a technically challenging procedure with high complication and conversion rates.…”

Section: Discussionmentioning

confidence: 99%

“…21,30,31 Primary laparoscopic RPLND for low stage testicular tumours has shown to have reduced morbidity compared with the open technique. 21,[30][31][32] However, post-chemotherapy laparoscopic RPLND is a technically challenging procedure with high complication and conversion rates. 33,34 Nevertheless, there is a role for the laparoscopic approach to RPLND in properly selected patients and with an appropriately skilled surgeon.…”

Section: Discussionmentioning

confidence: 99%

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Retroperitoneal lymph node dissection for metastatic germ cell tumours

Haldipur¹,

Devaraj²,

Shehata³

et al. 2011

annals

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Testicular germ cell tumours are the most common malignancies in men aged 15-40 years.1 There has been an increased incidence over the past few decades in the UK, 2,3 US 4 and other Caucasian populations. 5 Although the aetiology is unknown, developmental urogenital abnormalities, 6 undescended testes and inguinal hernias have all been associated with higher rates, 7 with sedentary lifestyle, early puberty and genetics also implicated as risk factors. 8-10The British Testicular Tumour Panel and Registry classifies malignant testicular germ cell tumours into two main histological groups: seminomas and teratomas. 11Para-aortic lymph nodes are the most common sites of metastatic disease.Along with the tumour pathology and clinical stage, preoperative staging investigations inform the choice of further treatment, which may be surveillance, chemotherapy or radiotherapy.12 Chemotherapy is usually recommended for those with evidence of metastatic disease while surgical resection is considered for patients with significant residual masses, particularly in the para-aortic region.Surgery is most likely to play a role in improving the outcome of treatment by resecting residual masses in intermediate and poor prognosis patients who are in remission following chemotherapy.Retroperitoneal lymph node dissection (RPLND) is the most common form of surgery required 13 and national guidance recommends that the treatment of patients with advanced disease or recurrence should be carried out in specialised centres.14 In the North Trent Cancer Network (NTCN), vascular surgeons have been members of the germ cell multidisciplinary team and patients requiring RPLND for metastatic testicular cancer have been treated by the vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours. MethodsAll patients diagnosed with testicular germ cell tumour in the NTCN between 1990 and 2009 were entered into a germ cell database. Patients referred to the vascular service for RPLND were identified through this database. The main indications for surgical referral were a residual para-aortic mass of >1-2cm after chemotherapy or as part of the treat- ABSTRACT inTRodUCTion in the north Trent Cancer network (nTCn) patients requiring retroperitoneal lymphadenectomy for metastatic testicular cancer have been treated by vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours. PaTiEnTS and mEThodS Patients referred by the nTCn to the vascular service for retroperitoneal lymphadenectomy between 1990 and 2009 were identified through a germ cell database. data were supplemented by a review of case notes to record histology, intraoperative and postoperative details. RESULTS a total of 64 patients were referred to the vascular service for retroperitoneal lymph node dissection, with a median age of 29 years (16-63 years) and a median follow-up of 4.9 years. Ten patients ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Retroperitoneal lymph node dissection for metastatic germ cell tumours

Haldipur¹,

Devaraj²,

Shehata³

et al. 2011

annals

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“…There is a steep learning curve with this procedure, but when performed at high volume centers the open conversion and perioperative morbidity rates in contemporary series have been acceptable. The most common reason for conversion to an open procedure is uncontrollable bleeding and vascular injury is cited as the most common intraoperative complication [Kenney and Tuerk, 2008;Neyer et al 2007;Abdel-Aziz et al 2006;Bhayani et al 2003]. In most contemporary series, the open conversion rate is55%, but conversions rates have been reported as high as 11.8% [Cresswell et al 2008;Skolarus et al 2008;Neyer et al 2007;Nielsen et al 2007;Albqami and Janetschek, 2005;Rassweiler et al 2000].…”

Section: Complications Of Lrplndmentioning

confidence: 99%

“…Postoperative complications have been reported at a rate of 9.4-25.7% in contemporary series [Cresswell et al 2008;Skolarus et al 2008;Neyer et al 2007;Nielsen et al 2007;Albqami and Janetschek, 2005]. Reported complications include chylous ascites, ileus, lymphocele, nerve injury, pulmonary embolus, C. difficile colitis, retroperitoneal hematoma and urinoma [Kenney and Tuerk, 2008].…”

Section: Complications Of Lrplndmentioning

confidence: 99%

Laparoscopic retroperitoneal lymph node dissection for stage I and II nonseminomatous germ-cell tumors

Guzzo¹,

Allaf²

2009

Therapeutic Advances in Urology

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Abstract:Objectives: Open retroperitoneal lymph node dissection has been traditionally used for the management of patients with nonseminomatous germ-cell tumors (NSGCTs). Over the last decade, laparoscopic retroperitoneal lymph node dissection (LRPLND) has gained popularity in several highly specialized centers. Methods: We retrospectively reviewed the English-language literature with regard to LRPLND. The perioperative and oncologic outcomes for patients with low stage NSGCTs who underwent LRPLND are summarized in this review with particular emphasis on contemporary studies. Results: Initially only used for staging, LRPLND has evolved to a therapeutic procedure capable of replicating the templates used for open RPLND. Perioperative outcomes including operative time, conversion rates and complications improve with surgeon experience and are acceptable at high volume centers. Oncologic outcomes are promising, but require longer term follow-up and the administration of adjuvant chemotherapy in many studies limits comparison to that of the open technique. Conclusion: LRPLND has been demonstrated to be feasible and safe at large volume institutions with experienced laparoscopic surgeons. LRPLND was originally performed as a staging procedure in patients with NSGCTs but has evolved into a therapeutic operation with early reports demonstrating short hospital stays and minimal morbidity. Further studies in larger cohorts of patients with longer term follow up are required to define the exact role of LRPLND.

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