title: Post-chemotherapy laparoscopic retroperitoneal lymph-node dissection in testis cancer patients.
abstract: OBJECTIVE
  Retroperitoneal lymph node dissection (RPLND) is still the most sensitive and specific method for the detection of malignant tumor and mature teratoma in stage II nonseminomatous testicular carcinoma after chemotherapy. Acceptance of this operation, however, has decreased because of the morbidity associated with the open approach. To reduce the morbidity and to improve the acceptance of RPLND, laparoscopy has been introduced. In this study, we describe our experiences with laparoscopic RPLND for stage II testicular carcinoma after chemotherapy.
  
  
  METHODS
  Sixteen patients underwent 17 laparoscopic RPLND after chemotherapy for clinical stage IIA-III nonseminomatous testicular cancer. Patients with post-chemotherapy residual masses >1 cm and normalization of tumor markers were considered for the procedure. Our dissection field included the resection of the residual tumor as well as the ipsilateral template.
  
  
  RESULTS
  Laparoscopic RPLND was completed in all patients. Operative time ranged from 125 to 370 minutes (mean 240 +/- 56 min). No transfusions were required, and no intra- or postoperative complications occurred because of the procedure. A bleomycin-induced interstitial pneumonia developed in one patient. After a mean follow-up period of 26 +/- 11 months (range 4 to 38), two disease recurrences were observed.
  
  
  CONCLUSIONS
  Laparoscopic RPLND after chemotherapy is a feasible and oncologically safe procedure. However, the technique is challenging and should only be performed in selected patients with low residual tumor volume.
authors.affiliation: Department of Urology, Eberhard-Karls-University, Tuebingen, Germany.
authors.forename: Rafael
authors.initials: R
authors.lastname: Maldonado-Valadez
authors.forename: David
authors.initials: D
authors.lastname: Schilling
authors.forename: Aristotelis G
authors.initials: AG
authors.lastname: Anastasiadis
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sturm
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Stefan
authors.initials: S
authors.lastname: Corvin
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents