AUA 2019: A Contemporary Review of Midline Extraperitoneal Retroperitoneal Lymph Node Dissection for Testicular Germ Cell Tumor

Chicago, IL ( While retroperitoneal lymph node dissection (RPLND) for testicular cancer has traditionally been performed through an open, transperitoneal approach, recently some centers have employed extraperitoneal approaches or minimally invasive approaches to attempt to decrease the potential morbidity of a transperitoneal procedure. Dr. Madeline Burg from the University of Southern California presented her group’s study evaluating the outcomes of patients undergoing midline extraperitoneal RPLND.

They utilized a testicular cancer database and evaluated 102 patients who underwent either primary or post-chemotherapy extraperitoneal RPLND from 2010-2017. They evaluated perioperative variables including estimated blood loss, blood transfusions, ability to perform nerve-sparing, concomitant intraabdominal procedures, nodal size, nodal yield, hospital length of stay, postoperative ejaculatory function, and 90-day complication rate.

They found that 30 patients underwent primary extraperitoneal RPLND while 72 underwent post-chemotherapy extraperitoneal RPLND. The median length of stay for patients was 3 days. 81% of patients underwent nerve-sparing procedures. 65% of patients had documented ejaculatory function post-operatively. 8% of patients had a complication within 90 days post-operatively. The median length of follow-up time was 590 days. Other surgical outcome data is available in Table 1.

AUA 2019 surgical outcomes

Burg concluded that midline extraperitoneal RPLND is a safe and effective procedure. They showed that the majority of patients have preserved ejaculatory function and that their length of stay and complication rates are comparable to minimally-invasive RPLND.

Presented by: Madeline Burg, MD Candidate, Keck School of Medicine, University of Southern California, Los Angeles, California

Written by: Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA. @btkmduro at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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