Midline Extraperitoneal Approach to Retroperitoneal Lymph Node Dissection in Testicular Cancer: Minimizing Surgical Morbidity

Syan-Bhanvadia, Sumeet; Bazargani, Soroush; Clifford, Thomas G.; Cai, Jie; Miranda, Gus; Daneshmand, Siamak

doi:10.1016/j.eururo.2017.02.024

Cited by 33 publications

(21 citation statements)

References 23 publications

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“…For R-RPLND, Harris et al demonstrated equivalent blood loss (75 mL, IQR 50–100 mL) and operative time (270.5 minutes (mins), IQR 236–299 mins) compared to L-RPLND [ 26 ]. Similarly, two other series reported a median blood loss of 50 mL [ 6 , 23 ], significantly less than the reported 184–450 mL blood loss for open primary RPLND [ 4 , 29 – 31 ].…”

Section: Discussionmentioning

confidence: 89%

“…Some O-RPLND series at experienced high-volume centers, however, have managed to reduce the difference in LOS compared to minimally invasive approaches. Syan-Bhanvadia et al via the extraperitoneal open approach and Beck et al of Indiana University have reported a mean LOS of 2.8 to 3 days [ 30 , 31 ]. The dramatically reduced hospitalization of R-RPLND is likely explained by both the less morbid incision compared to O-RPLND and the lower rates of postoperative ileus.…”

Section: Discussionmentioning

confidence: 99%

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A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Schwen

Gupta

Pierorazio

2018

Advances in Urology

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Objectives The robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) represents a new frontier in the surgical management of testicular cancer in the realm of minimally invasive urologic oncology. We aimed to review the early outcomes as compared to the laparoscopic and open approaches as well as describe the operative technique for the R-RPLND. Materials and Methods We reviewed all the literature related to the R-RPLND based on an electronic PubMed search up until July 2017. Results and Discussion Encouraged by favorable early oncologic and safety outcomes for treatment of clinical stage (CS) I nonseminomatous germ cell tumor (NSGCT), the R-RPLND affords the same recovery advantages as the laparoscopic retroperitoneal lymph node dissection (L-RPLND) while offering greater dexterity, superior visualization, and a theoretically shorter learning curve for the surgeon. While R-RPLND has a promising future in the management of patients with primary and postchemotherapy NSGCT, larger and more vigorous prospective studies are needed before supplanting the open RPLND as the gold standard approach for primary low-stage NSGCT or becoming an equivalent surgical modality in the postchemotherapy setting.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Schwen

Gupta

Pierorazio

2018

Advances in Urology

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“…Template dissections and nerve-sparing approaches are established methods for preventing retrograde ejaculation. Newer techniques with laparoscopy or a midline, extraperitoneal approach can also minimize morbidity including decreases in blood loss and length of hospitalization [ 6 , 7 ].…”

Section: Rationale For Retroperitoneal Lymph Node Dissectionmentioning

confidence: 99%

“…Most of the risk of surgery is associated with short-term complications including injury to retroperitoneal or peritoneal structures, ileus, bowel obstruction, chylous ascites, thromboembolism, and infection. We recently reported outcomes of our midline extraperitoneal approach to RPLND with no cases of ileus noted in 68 consecutive cases [ 6 ].…”

Section: Limitations and Safety Of Rplndmentioning

confidence: 99%

Retroperitoneal Lymph Node Dissection as Primary Treatment for Metastatic Seminoma

Daneshmand

2018

Advances in Urology

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Reducing the long-term morbidity in testicular cancer survivors represents a major area of interest. External beam radiation therapy and systemic chemotherapy are established treatments for seminoma; however, they are associated with late toxicities such as cardiovascular disease, insulin resistance, and secondary malignancy. Retroperitoneal lymph node dissection (RPLND) is a standard treatment for nonseminomatous germ cell tumors (NSGCT) that has minimal long-term morbidity. Given the efficacy of RPLND in management of NSGCT, interest has developed in this surgery as a front-line treatment for seminoma with isolated lymph node metastasis to the retroperitoneum. Four retrospective studies have shown promising results when surgery is performed for seminomas with low-volume retroperitoneal metastases. To better determine if RPLND can be recommended as a primary treatment option, two prospective clinical trials (SEMS and PRIMETEST) are underway. This review will examine the literature, discuss the benefits/limitations of RPLND, and compare the methodologies of the two ongoing clinical trials.

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“…Complications following postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) can be as high as 30% in some series, with ileus accounting for approximately half of these complications [6]. Recent advances in surgical techniques, including smaller incisions and use of a midline extraperitoneal approach, have led to virtual elimination of ileus in the vast majority of cases and a significantly shorter length of stay of 1-2 d, even after resection of large residual masses [7]. Surgeons performing PC-RPLND require intimate familiarity with the abdominal and retroperitoneal anatomy, need to be comfortable with vascular techniques and retrocrural resections, and must be prepared for adjunctive surgery as necessary.…”

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confidence: 99%

Advanced Testis Cancer

Daneshmand

2019

European Urology Focus

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Midline Extraperitoneal Approach to Retroperitoneal Lymph Node Dissection in Testicular Cancer: Minimizing Surgical Morbidity

Cited by 33 publications

References 23 publications

A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Retroperitoneal Lymph Node Dissection as Primary Treatment for Metastatic Seminoma

Advanced Testis Cancer

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