Extraperitoneal laparoscopic retroperitoneal lymph node dissection after chemotherapy for nonseminomatous testicular germ-cell tumor: surgical and oncological outcomes.
OBJECTIVE
To assess the surgical and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (RPLND) after chemotherapy.


METHODS
Twenty patients with metastatic nonseminomatous testicular germ-cell tumor underwent extraperitoneal laparoscopic RPLND after chemotherapy. The procedure was not indicated for patients with a pre-chemotherapy mass larger than 5 cm. Morbidity and oncological outcome were reviewed retrospectively. Surgical complications were graded according to the Clavien classification system.


RESULTS
Laparoscopic RPLND was completed in all patients, and there was no conversion to open surgery. The median operating time was 223 min (range, 137-399 min). The median blood loss was 20 ml (range, 10-520 ml). There were no intraoperative complications. Postoperatively, 4 patients (20 %) had prolonged lymphorrhea (grade I) and 9 (45 %) had chyle leakage (grade I). Histological examination of the residual mass revealed necrosis in 16 (80 %) and the presence of teratoma with/without viable tumor in 4 (20 %). With a median follow-up of 45 months (range, 24-112), no patient has had disease recurrence. Normal antegrade ejaculation was preserved in all of the 14 patients studied.


CONCLUSIONS
Extraperitoneal laparoscopic RPLND can be performed with acceptable morbidity and excellent cancer control in select patients. Surgeons should be aware of relatively high incidence of chyle leakage following this procedure.
Department of Urology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. yarai@uro.med.tohoku.ac.jp
Yoichi
Y
Arai
Yasuhiro
Y
Kaiho
Shigeyuki
S
Yamada
Hideo
H
Saito
Koji
K
Mitsuzuka
Shinichi
S
Yamashita
Shunichi
S
Namiki
Haruo
H
Nakagawa
Shigeto
S
Ishidoya
Akihiro
A
Ito
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D002945:Cisplatin / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D061646:Operative Time; D009919:Orchiectomy; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
D000970:Antineoplastic Agents; D002945:Cisplatin