Laparoscopic retroperitoneal lymph-node dissection in metastatic nonseminomatous germ-cell tumors

Published:August 18, 2022DOI:



      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.


      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).


      L-PC-RPLND, when adequately planned, is safe and effective for most patients with low to medium volume residual masses.


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        • Carver B.S.
        • Serio A.M.
        • Bajorin D.
        • Motzer R.J.
        • Stasi J.
        • Bosl G.J.
        • et al.
        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: 5603-5608
        • Kenigsberg A.P.
        • Lafin J.T.
        • Meng X.
        • Abe D.
        • Savalyeva A.
        • Singla N.
        • et al.
        Predictive capacity of miRNA-375 in identifying teratoma in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND).
        J Clin Oncol. 2020; 38 (416): 416
        • Leão R.
        • van Agthoven T.
        • Figueiredo A.
        • Jewett M.A.S.
        • Fadaak K.
        • Sweet J.
        • et al.
        Serum miRNA predicts viable disease after chemotherapy in patients with testicular nonseminoma germ cell tumor.
        J Urol. 2018; 200: 126-135
        • Professionals S.-O.
        EAU guidelines: testicular cancer.
        (Uroweb n.d.)
        Date accessed: September 5, 2021
      1. NCCN clinical practice guidelines in oncology.
        • Li R.
        • Duplisea J.J.
        • Petros F.G.
        • González G.M.N.
        • Tu S.-M.
        • Karam J.A.
        • et al.
        Robotic postchemotherapy retroperitoneal lymph node dissection for testicular cancer.
        Eur Urol Oncol. 2021; 4: 651-658
        • Nicolai N.
        • Bianchi E.
        • Donati I.
        • L'Acqua C.
        • Brunelli C.
        • Biasoni D.
        • et al.
        Quality of life and pain control following laparoscopic retroperitoneal lymph node dissection in early-stage nonseminoma.
        Tumori J. 2015; 101: 650-656
        • Nicolai N.
        • Cattaneo F.
        • Biasoni D.
        • Catanzaro M.
        • Torelli T.
        • Zazzara M.
        • et al.
        Laparoscopic postchemotherapy retroperitoneal lymph-node dissection can Be a standard option in defined nonseminomatous germ cell tumor patients.
        J Endourol. 2016; 30: 1112-1119
        • Winter C.
        • Pfister D.
        • Busch J.
        • Bingöl C.
        • Ranft U.
        • Schrader M.
        • et al.
        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: 403-409
        • Nazzani S.
        • Preisser F.
        • Mazzone E.
        • Tian Z.
        • Mistretta F.A.
        • Shariat S.F.
        • et al.
        In-hospital length of stay after major oncological surgical procedures.
        Eur J Surg Oncol. 2018; (0)
        • Busch J.
        • Magheli A.
        • Erber B.
        • Friedersdorff F.
        • Hoffmann I.
        • Kempkensteffen C.
        • et al.
        Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer--a single center analysis.
        BMC Urol. 2012; 12: 15
        • Arai Y.
        • Kaiho Y.
        • Yamada S.
        • Saito H.
        • Mitsuzuka K.
        • Yamashita S.
        • et al.
        Extraperitoneal laparoscopic retroperitoneal lymph node dissection after chemotherapy for nonseminomatous testicular germ-cell tumor: surgical and oncological outcomes.
        Int Urol Nephrol. 2012; 44: 1389-1395
        • Stepanian S.
        • Patel M.
        • Porter J.
        Robot-assisted laparoscopic retroperitoneal lymph node dissection for testicular cancer: evolution of the technique.
        Eur Urol. 2016; 70: 661-667
        • Calaway A.C.
        • Einhorn L.H.
        • Masterson T.A.
        • Foster R.S.
        • Cary C.
        Adverse surgical outcomes associated with robotic retroperitoneal lymph node dissection among patients with testicular cancer.
        Eur Urol. 2019; 76: 607-609
        • Permpongkosol S.
        • Lima G.C.
        • Warlick C.A.
        • Allaf M.E.
        • Varkarakis I.M.
        • Bagga H.S.
        • et al.
        Postchemotherapy laparoscopic retroperitoneal lymph node dissection: evaluation of complications.
        Urology. 2007; 69: 361-365
        • Steiner H.
        • Leonhartsberger N.
        • Stoehr B.
        • Peschel R.
        • Pichler R.
        Postchemotherapy laparoscopic retroperitoneal lymph node dissection for low-volume, stage II, nonseminomatous germ cell tumor: first 100 patients.
        Eur Urol. 2013; 63: 1013-1017
        • Nicolai N.
        • Tarabelloni N.
        • Gasperoni F.
        • Catanzaro M.
        • Stagni S.
        • Torelli T.
        • et al.
        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: 741-747
        • Fankhauser C.D.
        • Afferi L.
        • Stroup S.P.
        • Rocco N.R.
        • Olson K.
        • Bagrodia A.
        • et al.
        Minimally invasive retroperitoneal lymph node dissection for men with testis cancer: a retrospective cohort study of safety and feasibility.
        World J Urol. 2022;
        • Gerdtsson A.
        • Thor A.
        • Grenabo Bergdahl A.
        • Almås B.
        • Håkansson U.
        • Törnblom M.
        • et al.
        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)00036
        • Maldonado-Valadez R.
        • Schilling D.
        • Anastasiadis A.G.
        • Sturm W.
        • Stenzl A.
        • Corvin S.
        Post-chemotherapy laparoscopic retroperitoneal lymph-node dissection in testis cancer patients.
        J Endourol. 2007; 21: 1501-1504
        • Heidenreich A.
        • Pfister D.
        • Witthuhn R.
        • Thüer D.
        • Albers P.
        Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection.
        Eur Urol. 2009; 55: 217-224
        • Nicolai N.
        • Biasoni D.
        • Catanzaro M.A.
        • Colecchia M.
        • Trama A.
        • RARECAREnet Working Group
        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: 60-66