Purpose: Retroperitoneal lymph node dissection (RPLND) is performed in patients with advanced nonseminomatous (NSGCT) germ cell tumors and residual retroperitoneal mass post-chemotherapy.
The extent of node dissection remains unclear. Ipsilateral template dissection is a compromise between morbidity and oncological efficacy. Here, we compare ipsilateral with primary bilateral laparoscopic (L)-RPLND after chemotherapy in terms of morbidity and oncological safety.
Patients and Methods: Nineteen laparoscopic ipsilateral L-RPLNDs (Group A) after platinum-based chemotherapy in patients with clinical stage IIA-III NSGCT were performed, while 20 patients underwent primary bilateral L-RPLND (Group B). We included patients with residuals localized in the retroperitoneum >1 cm and a tumor marker negativity after chemotherapy. The patients in group B had nerve sparing based on their respective tumor volume.
Results: All L-RPLND was successfully finished without conversion. Mean operative time in group A was 221 minutes and 270 minutes in group B (p=0.12). There were no deviations from the normal postoperative course in 36 cases. There was one Grade II complication (bleomycin-induced pneumonitis) in group A and 1 grade III complication (chylous ascites) in group B. The mean hospitalization time in both groups was 5 days (p=0.1). With regard to the overall rate of disease recurrence, no significant difference was found between both groups (HR=1.84; 95% CI 0.17-39.92; p=0.6109).
Conclusions: Postchemotherapy L-RPLND remains technically challenging. However, the morbidity of primary bilateral post-chemotherapy L-RPLND is similar to that of template dissection. Additional oncological safety is provided, which is particularly relevant in patients with more extensive retroperitoneal tumor volume.
Written by:
Aufderklamm S, Todenhöfer T, Hennenlotter J, Gakis G, Mischinger J, Mundhenk J, Germann M, Stenzl A, Schwentner C. Are you the author?
Department of Urology, Eberhard Karls University, Tuebingen, Germany.
Reference: J Endourol. 2013 Jul;27(7):856-61.
doi: 10.1089/end.2012.0648
PubMed Abstract
PMID: 23516988
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