Management of adult Leydig-cell testicular tumors: assessing the role of laparoscopic retroperitoneal lymph node dissection.
OBJECTIVE
Leydig-cell tumors represent <5% of malignant testicular tumors in adults. Orchiectomy is curative in approximately 90% of cases; however, the remaining men can develop metastases refractory to chemotherapy and radiation. We evaluated the role of laparoscopic retroperitoneal lymph node dissection (RPLND) in adult Leydig-cell tumors.


METHODS
Between 1999 and 2001, laparoscopic RPLND was performed with four transperitoneal ports within a unilateral template for six patients with pure Leydig-cell tumors. Presenting signs and symptoms, operative time, blood loss, intraoperative complications, postoperative complications, length of hospitalization, pathology reports, ejaculatory function, and survival were reviewed retrospectively.


RESULTS
Laparoscopic RPLND was successful, without open conversions or reinterventions. Two vascular injuries occurred during dissection; additional intraoperative complications were not observed. Postoperatively, one patient developed erysipelas, but no other postoperative complications were recorded. The mean operative time was 190 minutes, and the mean length of hospitalization was 4.3 days. Pathologic analysis of lymph nodes revealed no evidence of metastatic Leydig-cell tumor. At 12 months' mean follow-up (range 3-29 months), no recurrences have been identified.


CONCLUSIONS
Laparoscopic RPLND is a safe, minimally invasive procedure for Leydig-cell tumors. Additional clinical experience is required to evaluate its effectiveness for pathologic stage II tumors and to determine if a therapeutic advantage can be realized with a protocol employing laparoscopic RPLND for adult Leydig-cell tumors.
Peschel
Reinhard
R
Clinic of Urology, Innsbruck, Austria.
Gettman
Matthew T
MT
Steiner
Hannes
H
Neururer
Richard
R
Bartsch
Georg
G
D000328:Adult; D006801:Humans; D010535:Laparoscopy; D007984:Leydig Cell Tumor / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000601:surgery*