Oncologic efficacy of laparoscopic RPLND in treatment of clinical stage I nonseminomatous germ cell testicular cancer.
OBJECTIVE
To assess the oncologic efficacy of laparoscopic retroperitoneal lymph node dissection (LRPLND) for clinical Stage I nonseminomatous germ cell tumors (NSGCTs) in a large multi-institutional series. LRPLND is emerging as a less-invasive alternative in the adjuvant surgical treatment of patients with testicular cancer.


METHODS
The medical records of 120 patients with clinical Stage I NSGCT who underwent LRPLND at one of four institutions in the United States were retrospectively analyzed. All patients had at least 12 months of postoperative follow-up. The modified template dissection was performed at all centers. For the purposes of analysis, the patients were divided into two groups: those with consonant clinical and pathologic Stage I disease (n = 74, 62%) and those upstaged to pathologic Stage II (n = 46, 38%).


RESULTS
No patient, including those upstaged to pathologic Stage II disease undergoing surveillance (n = 10), presented with retroperitoneal recurrence after LRPLND. Two patients with consonant pathologic Stage I developed pelvic recurrence that was outside the standard dissection template. The median follow-up for the patients with pathologic Stage I was 28.5 months (range 12 to 144) and was 29 months (range 12 to 108) for those with pathologic Stage II.


CONCLUSIONS
In this group of patients with clinical Stage I NSGCT, management at multiple institutions that included LRPLND provided excellent intermediate results, paralleling those historically achieved with open lymph node dissection.
D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D009919:Orchiectomy; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*