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

Published:August 18, 2022DOI:https://doi.org/10.1016/j.ejso.2022.08.014

      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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