title: Laparoscopic retroperitoneal lymph node dissection for low-stage cancer: a Washington University update.
abstract: OBJECTIVE
  At present, open retroperitoneal lymph node dissection (RPLND) remains the preferred approach at many high-volume centers for the surgical treatment of patients with low-stage testis cancer. Despite the potential advantages of a minimally invasive approach, including improved cosmesis and shorter recovery times, there remain concerns over the quality of dissection and oncologic control offered through a minimally invasive approach. Our objective was to critically evaluate the safety and intermediate-term oncologic efficacy of laparoscopic RPLND (L-RPLND).
  
  
  METHODS
  A retrospective chart review was performed, evaluating all patients who underwent L-RPLND between 2003 and 2009. Patient records were updated by telephone interview.
  
  
  RESULTS
  A total of 59 patients underwent L-RPLND during the study period, of which 13 had previously undergone chemotherapy. Mean age at treatment was 32 years. Mean operative time and estimated blood loss were 291 minutes (176-620 min) and 184 mL (range 0-1800 mL), respectively. Mean lymph node count was 21.6 (range 5-48). Mean hospital stay was 2 days (range 1-4 d). There were three open conversions because of intraoperative complications. One patient needed a transfusion. Five patients had six (8.5%) postoperative complications: three lymphoceles, two chylous ascites, and one deep venous thrombosis/pulmonary embolus. Of 18 patients with node-positive pathology, 13 received adjuvant chemotherapy and 5 underwent surveillance. Retroperitoneal recurrence did not develop in any patient undergoing surveillance during a mean follow-up of 21.3 months. One postchemotherapy RPLND (1.7%) patient experienced a retroperitoneal recurrence.
  
  
  CONCLUSIONS
  L-RPLND is a diagnostic and therapeutic treatment option for patients with low-stage testis cancer, offering excellent oncologic control and acceptable perioperative morbidity. Intermediate-term results suggest that L-RPLND is a viable alternative to the open surgical procedure. Carefully selected patients may be candidates for L-RPLND in the postchemotherapy setting.
authors.affiliation: Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Gardner
authors.forename: Timur M
authors.initials: TM
authors.lastname: Roytman
authors.forename: Cathy
authors.initials: C
authors.lastname: Chen
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
mesh_terms: D000328:Adult; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D012187:Retroperitoneal Space / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D014495:Universities; D014861:Washington