[Primary laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ-cell testis tumor].
BACKGROUND
this report is intended to retrospectively assess cancer control and morbidity of primary laparoscopic reproperitoneal lymphadenectomy (L-RPLND) in patients with clinical Stage I non seminomatous germ cell tumour (NSGCT).


METHODS
one hundred and sixty-four patients with clinical Stage I NSGCT underwent primary diagnostic LRPLND between 1993 and 2006. Patients were operated unilaterally limiting the dissection to templates. Kaplan Meier curves were generated estimating time to recurrence.


RESULTS
of the 164 patients, 82 (48%) had embryonal components and 35 (20%) lymphovascular invasion in the orchiectomy specimen. The median (IQR) age, operative time, length of hospital stay, blood loss and number of lymph nodes retrieved was 28 years (24-33), 135 minutes. (120- 180), 48 hours (24-48), 50 cc (20-100) and 14 (10-18) nodes, respectively. All patients had negative serum markers preoperatively. Presence of lymph node metastasis was identified in 32 (19.5%) patients. Follow-up was available in 15 of these. Fourteen received adjuvant chemotherapy and 2 of them had recurrence at 3 and 64 months. Absence of lymph node metastasis was diagnosed in 132 (80.5%) patients. Follow-up was available in 80 of these. Among them 7 recurred (5 retroperitoneum, 2 lung), one of them 33 months after L-RPLND. Median follow-up for patients without recurrence was 14 months (IQR:4-35). The cumulative 3-year recurrence free rate was 82% (95%CI: 64-91). Seventeen (10%) of 164 patients had intra or perioperative complications.


CONCLUSIONS
this is the largest series of L-RPLND performed in a single institution. Both morbidity and oncologic safety of this technique needs to be prospectively evaluated in randomized trials.
Departamento de Urología, Clínica Indisa, Santiago, Chile. octaviocastillo@vtr.net
O A
OA
Castillo
R
R
Sánchez-Salas
F P
FP
Secin
J M
JM
Campero
A
A
Foneron
I
I
Vidal-Mora
D000328:Adult; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult