Long-term results of laparoscopic retroperitoneal lymph node dissection: a single-center 10-year experience.
OBJECTIVE
To evaluate the feasibility, morbidity, and long-term oncologic efficacy of laparoscopic retroperitoneal lymph node dissection (L-RPLND) in patients with nonseminomatous germ cell tumor (NSGCT).


METHODS
L-RPLND was performed 188 times in 185 patients; 114 procedures were performed for Stage I NSGCT and 6 procedures for tumor marker-negative clinical Stage IIA disease. In the case of positive lymph nodes, adjuvant cisplatin-based chemotherapy was administered. After chemotherapy, L-RPLND was performed for retroperitoneal Stage IIA (10 patients), IIB (43 patients), and IIC lesions (15 patients).


RESULTS
The mean operative time was 256 minutes for Stage I and 243 minutes for Stage II; the conversion rate was 2.6%. The mean blood loss was 159 mL in patients with Stage I and 78 mL in those with Stage II disease. Active tumor was found in 19.5% of patients with Stage I lesions and in 50% of patients with tumor marker-negative clinical Stage IIA disease. After chemotherapy, active tumor was found in 1 patient with Stage IIC disease and mature teratoma in 38.2% of patients. The mean postoperative hospital stay for those with Stage I and II disease was 4.1 and 3.7 days, respectively. Antegrade ejaculation was preserved in 98.4% of patients. The mean follow-up was 53.7 months for those with Stage I and 57.6 months for those with Stage II disease. All but 6 patients have remained free of relapse, and no patient died of tumor progression.


CONCLUSIONS
The rate of tumor control after L-RPLND and the diagnostic accuracy of L-RPLND were equal to the open procedure, and the morbidity was significantly lower. Therefore, L-RPLND for Stage I and low-volume retroperitoneal Stage II disease can be performed at centers with experience in urologic laparoscopy and oncology.
Steiner
Hannes
H
Department of Urology, University of Innsbruck, Innsbruck, Austria.
Peschel
Reinhard
R
Janetschek
Günter
G
Höltl
Lorenz
L
Berger
Andreas P
AP
Bartsch
Georg
G
Hobisch
Alfred
A
D003131:Combined Modality Therapy; D005240:Feasibility Studies; D018237:Germinoma / Q000556:secondary* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013724:Teratoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome