Laparoscopic retroperitoneal lymph node dissection after chemotherapy.
OBJECTIVE
To assess the operative feasibility, clinical outcomes, and complications of laparoscopic retroperitoneal lymphadenectomy (RPLND) after chemotherapy.


METHODS
A retrospective review of clinical records from 7 patients who underwent laparoscopic RPLND after chemotherapy was performed. Five patients presented with nonseminomatous germ cell tumor after orchiectomy. One patient was diagnosed with pure seminoma and one with epididymal small cell cancer. All 7 patients received multiagent chemotherapy for clinical Stage IIA or higher disease, followed by laparoscopic RPLND for findings of a residual retroperitoneal mass on computed tomography or a prechemotherapy mass size greater than 3.0 cm. The mean tumor diameter was 3.07 cm before chemotherapy and 1.91 cm after chemotherapy. A modified laparoscopic left (n = 3), right (n = 3), and bilateral (n = 1) template was used. None of the patients had received radiotherapy before surgery.


RESULTS
Postchemotherapy laparoscopic RPLND was successfully completed in 5 (71.4%) of 7 patients. Two patients required a conversion to open surgery. The overall complication rate was 57.1% (4 of 7), with a major complication incidence of 42.8% (3 of 7). No mortalities were recorded. Of the 5 patients who presented with nonseminomatous germ cell tumor after orchiectomy, 3 were found to have retroperitoneal lymph nodes consistent with mature teratoma, 1 had necrotic tissue, and 1 had residual viable tumor.


CONCLUSIONS
Laparoscopic RPLND is a feasible operation in patients after systemic chemotherapy. This technique remains challenging at this time and should be reserved for patients with limited residual disease and should only be performed at institutions with considerable laparoscopic expertise.
Palese
Michael A
MA
Department of Surgery, Division of Urology, University of Maryland Medical System, Baltimore, Maryland, USA.
Su
Li-Ming
LM
Kavoussi
Louis R
LR
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D012189:Retrospective Studies; D018239:Seminoma / Q000175:diagnosis / Q000188:drug therapy; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy*
D014408:Biomarkers, Tumor