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

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 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.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2022 Aug 19 [Epub ahead of print]

Sebastiano Nazzani, Silvia Stagni, Davide Biasoni, Mario Catanzaro, Alberto Macchi, Antonio Tesone, Tullio Torelli, Ruggero Darisi, Vito Lo Russo, Claudia Colbacchini, Rodolfo Lanocita, Tommaso Cascella, Melanie Claps, Patrizia Giannatempo, Matteo Zimatore, Laura Cattaneo, Emanuele Montanari, Roberto Salvioni, Nicola Nicolai

Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy., Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Padova, Italy., Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Università degli Studi di Milano, Milan, Italy., Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Testis surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: .

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