Laparoscopic and open retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testis tumors.
OBJECTIVE
Laparoscopic retroperitoneal lymph node dissection (L-RPLND) has been reported as efficacious for staging of the retroperitoneum in patients with stage I nonseminomatous germ-cell testis tumors (NSGCT). However, reports are limited to a few centers, and this procedure has yet to be widely accepted as an alternative to open retroperitoneal lymph node dissection (O-RPLND). Thus, we compared our contemporary open and laparoscopic experience with RPLND.


METHODS
A retrospective chart review identified 28 patients who underwent either open (N = 6) or laparoscopic (N = 22) RPLND for clinical stage I NSGCT since 2000. Each patient received the appropriate modified template dissection. Perioperative demographic data, histologic nodal status, and recurrence data were evaluated. The mean follow-up was similar in the two groups.


RESULTS
The mean operative time was not significantly different (313 minutes for L-RPLND v 284 minutes for O-RPLND). However, L-RPLND did have a significantly shorter hospitalization (1.2 v 8.5 days). Significantly more lymph nodes were removed with O-LPLND than with L-RPLND (mean 33 v 17). There was a single recurrence outside the modified template after both L-RPLND and O-RPLND and one within-the-template recurrence in the O-RPLND group.


CONCLUSIONS
The L-RPLND is associated with less blood loss and a shorter hospital stay than O-RPLND, whereas the lymph-node yield of O-RPLND is greater. However, during the critical early follow-up period, the oncologic effectiveness and morbidity of L-RPLND for clinical stage I NSGCT appears similar to that of O-RPLND.
Abdel-Aziz
Khaled F
KF
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Anderson
J Kyle
JK
Svatek
Robert
R
Margulis
Vitaly
V
Sagalowsky
Arthur I
AI
Cadeddu
Jeffrey A
JA
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery*; D009919:Orchiectomy; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome