Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer--a single center analysis.
BACKGROUND
The open approach represents the gold standard for postchemotherapy retroperitoneal lymph node dissection (O-PCLND) in patients with residual testicular cancer. We analyzed laparoscopic postchemotherapy retroperitoneal lymph node dissection (L-PCLND) and O-PCLND at our institution.


METHODS
Patients underwent either L-PCLND (n = 43) or O-PCLND (n = 24). Categorical and continuous variables were compared using the Fisher exact test and Mann-Whitney U test respectively. Overall survival was evaluated with the log-rank test.


RESULTS
Primary histology was embryonal cell carcinomas (18 patients), pure seminoma (2 cases) and mixed NSGCTs (47 patients). According to the IGCCCG patients were categorized into "good", "intermediate" and "poor prognosis" disease in 55.2%, 14.9% and 20.8%, respectively. Median operative time for L-PCLND was 212 min and 232 min for O-PCLND (p = 0.256). Median postoperative duration of drainage and hospital stay was shorter after L-PCLND (0.0 vs. 3.5 days; p < 0.001 and 6.0 vs. 11.5 days; p = 0.002). Intraoperative complications occurred in 21.7% (L-PCLND) and 38.0% (O-PCLND) of cases with 19.5% and 28.5% of Clavien Grade III complications for L-PCLND and O-PCLND, respectively (p = 0.224). Significant blood loss (>500 ml) was almost equally distributed (8.6% vs. 14.2%: p = 0.076). No significant differences were observed for injuries of major vessels and postoperative complications (p = 0.758; p = 0.370). Tumor recurrence occurred in 8.6% following L-PCLND and in 14.2% following O-PCLND with a mean disease-free survival of 76.6 and 89.2 months, respectively. Overall survival was 83.3 and 95.0 months for L-PCNLD and O-PCLND, respectively (p = 0.447).


CONCLUSIONS
L-PCLND represents a safe surgical option for well selected patients at an experienced center.
Charité University Medicine Berlin, Department of Urology, Berlin, Germany.
Jonas
J
Busch
Ahmed
A
Magheli
Barbara
B
Erber
Frank
F
Friedersdorff
Ivan
I
Hoffmann
Carsten
C
Kempkensteffen
Steffen
S
Weikert
Kurt
K
Miller
Mark
M
Schrader
Stefan
S
Hinz
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018236:Carcinoma, Embryonal / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000601:surgery*; D061646:Operative Time; D011379:Prognosis; D012187:Retroperitoneal Space; D018239:Seminoma / Q000188:drug therapy / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
D000970:Antineoplastic Agents