title: Postchemotherapy laparoscopic retroperitoneal lymph node dissection in nonseminomatous germ-cell tumor.
abstract: OBJECTIVE
  Postchemotherapy retroperitoneal lymph node dissection (RPLND) remains essential in the management of metastatic testicular carcinoma and represents a surgical challenge. We determined to assess the feasibility and complications of laparoscopic RPLND in patients who were treated with induction chemotherapy for testis cancer.
  
  
  METHODS
  We performed a retrospective analysis of data that was prospectively recorded from 26 patients who underwent laparoscopic RPLND postplatinum-based chemotherapy between 2000 and 2006. The surgical technique consisted of excision of the residual mass plus unilateral template dissection. A transperitoneal technique was used in 24 patients, and an extraperitoneal approach was used in 2 patients. Operative details, perioperative morbidity data, and histologic findings were assessed for the study.
  
  
  RESULTS
  Primary pathologic evaluation of the testis tumor revealed pure embryonal carcinoma in 4 patients, teratocarcinoma in 1 patient, and mixed nonseminomatous germ-cell tumors in 21 patients. All patients had residual disease in the retroperitoneum on a preoperative CT scan, with a median size of 3.4 cm (range 2-6 cm). Procedures in three (11.5%) patients were converted to open surgery. Median operative time was 183 minutes (range 120-260 min). Median estimated blood loss was 400 mL (range 100-600 mL), and blood transfusion was necessary in one patient. Median hospital stay was 5 days (range 2-6 d). Median number of lymph nodes obtained on final histologic examination was 7 (range 4-13). Perioperative complications included eight lymphovascular and one intestinal. At a mean follow-up of 27 months (range 14-36 mos), no recurrences have been observed and no patient was lost to follow-up.
  
  
  CONCLUSIONS
  Postchemotherapy laparoscopic RPLND is technically feasible. The most frequent complications and causes of conversion are lymphovascular.
authors.affiliation: Department of Urology, Institut Montsouris/Université Paris Descartes, Paris, France.
authors.forename: Jean-Patrice
authors.initials: JP
authors.lastname: Calestroupat
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Francois
authors.initials: F
authors.lastname: Rozet
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.forename: Gordon
authors.initials: G
authors.lastname: Smyth
authors.forename: Ali
authors.initials: A
authors.lastname: Kasraeian
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien