Results of bilateral nerve sparing laparoscopic retroperitoneal lymph node dissection for testicular cancer.
OBJECTIVE
We evaluated the feasibility and early oncological outcome of a laparoscopic nerve sparing bilateral retroperitoneal lymph node dissection. The surgical technique is described.


METHODS
From July 2004 to December 2007 a total of 42 patients with nonseminomatous germ cell tumor (21 with stage I, 2 with stage IIA marker negative and 19 with post-chemotherapy stage IIB disease) underwent transperitoneal bilateral laparoscopic retroperitoneal lymph node dissection. The sympathetic trunk and postganglionic nerves were identified, and lymphatic tissue was dissected between the nerves. Patients with clinical stage I and IIA disease that was lymph node positive at laparoscopic retroperitoneal lymph node dissection did not receive additional chemotherapy.


RESULTS
Surgery was successfully completed in all patients and no conversion to open surgery was necessary. Mean operative time was 323 minutes. No intraoperative complications occurred. Of patients with stage I and marker negative stage IIA disease active tumor was found in 5 retroperitoneal lymph node dissection specimens, and no patients had recurrence. Of 19 patients with post-chemotherapy stage IIB disease teratoma was found in the lymphatic tissue in 4 (21.0%). No retroperitoneal recurrence was observed. Pulmonary metastases developed 9 months after surgery in 1 patient with stage I disease and negative retroperitoneal histology, and were treated successfully. All patients are currently free of disease at a mean followup of 17.2 months. Antegrade ejaculation was preserved in 36 patients (85.7%).


CONCLUSIONS
Bilateral nerve sparing laparoscopic retroperitoneal lymph node dissection is feasible and associated with low morbidity if performed by experienced hands. The oncological efficacy of this approach is promising and currently under evaluation.
Steiner
Hannes
H
Department of Urology, Medical University Innsbruck, Innsbruck, Austria. hannes.steiner@uki.at
Zangerl
Florian
F
Stöhr
Brigitte
B
Granig
Thomas
T
Ho
Henry
H
Bartsch
Georg
G
Peschel
Reinhard
R
D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D018237:Germinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010525:Peripheral Nerves; D012187:Retroperitoneal Space; D018570:Risk Assessment; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013737:Testis / Q000294:innervation / Q000601:surgery; D016896:Treatment Outcome