Abstract
Objectives
To support laparoscopic post-chemotherapy retroperitoneal lymph-node dissection (L-PC-RPLND)
as a potential new standard, we report on a large dataset of patients systematically
undergoing L-PC-RPLND.
Patients and methods
Patients with unilateral residual mass (≥1 cm), normalized markers, limited encasement
(<30%) of gross retroperitoneal vessels underwent unilateral L-PC-RPLND with no adjuvant
chemotherapy. Surgical performances, histology, hospital stay, complications within
30 days and follow-up visits were recorded. Multivariable linear and logistic regression
models were used.
Results
Between February 2011 and January 2021, 151 consecutive patients underwent L-PC-RPLND.
Median size of the residual mass was 25 mm (interquartile range [IQR] 20–35 mm). Overall
median operative time was 208 min (IQR 177–241) and was 51 min longer (p-value <0.001)
for right L-PC-RPLNDs. Eleven procedures were converted to open surgery. Median number
of removed and positive nodes was 11 (IQR 8–16) and 1 (IQR 1–2), respectively. Mean
hospital stay was 2 days (IQR 2–3). Nine complications (6%) occurred: two were Clavien-Dindo
grade III. Definitive pathology revealed post-pubertal teratoma in 65.6%, fibro-necrotic
tissue in 23.8%, teratoma with malignant somatic component in 6.6% and viable tumour
in 4.0% patients. In multivariable linear regression models, fibro-necrotic tissue
(32 min, CI 8.5–55.5; p < 0.01) and residual volume (1.05 min, CI 0.24–1.85; p < 0.01)
achieved independent predictor status for longer operative time. All patients, but
one, are alive and disease-free after a median follow-up of 22 months (IQR 10, 48).
Conclusion
L-PC-RPLND, when adequately planned, is safe and effective for most patients with
low to medium volume residual masses.
Keywords
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References
- Improved clinical outcome in recent years for men with metastatic nonseminomatous germ cell tumors.J Clin Oncol Off J Am Soc Clin Oncol. 2007; 25: 5603-5608https://doi.org/10.1200/JCO.2007.13.6283
- Predictive capacity of miRNA-375 in identifying teratoma in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND).J Clin Oncol. 2020; 38 (416): 416https://doi.org/10.1200/JCO.2020.38.6_suppl.416
- Serum miRNA predicts viable disease after chemotherapy in patients with testicular nonseminoma germ cell tumor.J Urol. 2018; 200: 126-135https://doi.org/10.1016/j.juro.2018.02.068
- EAU guidelines: testicular cancer.(Uroweb n.d.)https://uroweb.org/guideline/testicular-cancer/Date accessed: September 5, 2021
- NCCN clinical practice guidelines in oncology.(n.d)https://www.nccn.org/professionals/physician_gls/default.aspxDate accessed: April 20, 2022
- Robotic postchemotherapy retroperitoneal lymph node dissection for testicular cancer.Eur Urol Oncol. 2021; 4: 651-658https://doi.org/10.1016/j.euo.2019.01.014
- Quality of life and pain control following laparoscopic retroperitoneal lymph node dissection in early-stage nonseminoma.Tumori J. 2015; 101: 650-656https://doi.org/10.5301/tj.5000354
- Laparoscopic postchemotherapy retroperitoneal lymph-node dissection can Be a standard option in defined nonseminomatous germ cell tumor patients.J Endourol. 2016; 30: 1112-1119https://doi.org/10.1089/end.2016.0458
- Residual tumor size and IGCCCG risk classification predict additional vascular procedures in patients with germ cell tumors and residual tumor resection: a multicenter analysis of the German Testicular Cancer Study Group.Eur Urol. 2012; 61: 403-409https://doi.org/10.1016/j.eururo.2011.10.045
- In-hospital length of stay after major oncological surgical procedures.Eur J Surg Oncol. 2018; (0)https://doi.org/10.1016/j.ejso.2018.05.001
- Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer--a single center analysis.BMC Urol. 2012; 12: 15https://doi.org/10.1186/1471-2490-12-15
- Extraperitoneal laparoscopic retroperitoneal lymph node dissection after chemotherapy for nonseminomatous testicular germ-cell tumor: surgical and oncological outcomes.Int Urol Nephrol. 2012; 44: 1389-1395https://doi.org/10.1007/s11255-012-0195-z
- Robot-assisted laparoscopic retroperitoneal lymph node dissection for testicular cancer: evolution of the technique.Eur Urol. 2016; 70: 661-667https://doi.org/10.1016/j.eururo.2016.03.031
- Adverse surgical outcomes associated with robotic retroperitoneal lymph node dissection among patients with testicular cancer.Eur Urol. 2019; 76: 607-609https://doi.org/10.1016/j.eururo.2019.05.031
- Postchemotherapy laparoscopic retroperitoneal lymph node dissection: evaluation of complications.Urology. 2007; 69: 361-365https://doi.org/10.1016/j.urology.2006.10.020
- Postchemotherapy laparoscopic retroperitoneal lymph node dissection for low-volume, stage II, nonseminomatous germ cell tumor: first 100 patients.Eur Urol. 2013; 63: 1013-1017https://doi.org/10.1016/j.eururo.2012.09.036
- Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: safety and efficacy analyses at a high volume center.J Urol. 2018; 199: 741-747https://doi.org/10.1016/j.juro.2017.09.088
- Minimally invasive retroperitoneal lymph node dissection for men with testis cancer: a retrospective cohort study of safety and feasibility.World J Urol. 2022; https://doi.org/10.1007/s00345-022-03974-9
- Unilateral or bilateral retroperitoneal lymph node dissection in nonseminoma patients with postchemotherapy residual tumour? Results from RETROP, a population-based mapping study by the Swedish Norwegian testicular cancer Group.Eur Urol Oncol. 2021; (S2588-9311) (5)00036https://doi.org/10.1016/j.euo.2021.02.002
- Post-chemotherapy laparoscopic retroperitoneal lymph-node dissection in testis cancer patients.J Endourol. 2007; 21: 1501-1504https://doi.org/10.1089/end.2006.0441
- Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection.Eur Urol. 2009; 55: 217-224https://doi.org/10.1016/j.eururo.2008.09.027
- Testicular germ-cell tumours and penile squamous cell carcinoma: appropriate management makes the difference.Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2019; 45: 60-66https://doi.org/10.1016/j.ejso.2018.02.006
Article info
Publication history
Published online: August 18, 2022
Accepted:
August 15,
2022
Received in revised form:
August 1,
2022
Received:
May 16,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
