Laparoscopic Retroperitoneal Lymph Node Dissection as a Safe Procedure for Postchemotherapy Residual Mass in Testicular Cancer

To evaluate the feasibility, clinical and perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) in the management of patients with germ cell tumors (GCT) and residual post-chemotherapy mass.

We report our experience of 25 patients treated with L-RPLND between 2008 and 2015. All 25 patients were diagnosed with GCT by primary pathological evaluation of the specimens after orchiectomy. All patients received cisplatin-based chemotherapy. The technique consisted of L-RPLND excision of the residual mass using unilateral template dissection. We assessed perioperative data and histological findings.

Surgery was successfully completed in 24 (96%) patients, 1 patient required an open surgery due to intense adhesions of the mass to the inferior vena cava. Mean operation time was 213 minutes. Mean blood loss was 260 mL. Postoperative complications were upper limb osteomuscular pain in 2 patients and chylous ascites in 1 patient. Mean postoperative hospital stay was 2 days. The median residual mass diameter was 3.3 cm (range 1.1-6.6 cm). Histopathological findings were necrotic tissue in 9 patients, teratoma in 9 patients, viable tumor in 6 patients, and Castleman disease in 1 patient. The median follow-up was 30 months. Normal antegrade ejaculation was preserved in all patients.

Laparoscopic postchemotherapy RPLND is a feasible, safe, and highly oncologically efficient procedure, which has the benefits of minimally invasive surgery.

Journal of laparoendoscopic & advanced surgical techniques. Part A. 2017 Dec 07 [Epub ahead of print]

Eliney Ferreira Faria, Hugo Silva Neves, Breno Dauster, Roberto Dias Machado, Wesley Justino Magnabosco, Roberto Lodeiro Muller, Alexandre César Santos, Marcos Tobias-Machado

1 Department of Surgical Urologic Oncology, Hospital de Amor de Barretos, Barretos, SP, Brazil ., 2 Department of Urology, Hospital São Rafael, Salvador, BA, Brazil ., 3 Department of Surgical Urologic Oncology, Centro de Pesquisas Oncológicas, Florianópolis, SC, Brazil ., 4 Department of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil .