title: [Post-chemotherapy laparoscopic retroperitoneal lymph node dissection in low volume residual germ cell cancer: a technique to reduce morbidity].
abstract: OBJECTIVE
  Retroperitoneal lymph node dissection (RPLND) is the most appropriate method for the detection of residual tumor tissue and mature teratoma after chemotherapy in patients with advanced nonseminomatous (NSGCT) or seminomatous (SGCT) germ cell tumors in clinical stage II-III. Open surgical procedures are associated with higher morbidity rates and laparoscopic RPLND offers a minimally invasive procedure with equivalent oncological safety and low morbidity.
  
  
  METHODS
  In 39 patients laparoscopic RPLND (L-RPLND) after platinum-based chemotherapy for clinical stage IIa-III NSGCT was performed unilaterally as well as bilaterally by two surgeons. Patients with retroperitoneal residual tumor >1 cm and normalization of tumor markers after chemotherapy were included. Bilateral L-RPLND was performed with complete contralateral nerve sparing while the decision for ipsilateral nerve preservation was based on the volume of the residual mass in the respective standard field.
  
  
  RESULTS
  The L-RPLND was completed in all patients without conversion. Median operation time was 248 min (range 95-397 min) and mean hospitalization time was 5 days (range 3-14 days). Furthermore, there was no difference in recurrence rate of the disease (p=0.45) between patients with unilateral or bilateral dissection. The postoperative ejaculatory function was normal in 37 out of 39 patients. The median follow-up period was 18.5 months (range 3-38 months) and 3 out of 39 patients developed recurrence (7.69 %).
  
  
  CONCLUSIONS
  Post-chemotherapy L-RPLND is feasible with a lower complication rate and an adequate oncological safety and functional outcome. Due to the complexity of L-RPLND the procedure remains limited to institutions with extensive laparoscopic experience.
authors: Klinik für Urologie, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Deutschland.
authors: S
authors: S
authors: Aufderklamm
authors: T
authors: T
authors: Todenhöfer
authors: J
authors: J
authors: Hennenlotter
authors: G
authors: G
authors: Gakis
authors: J
authors: J
authors: Mischinger
authors: J
authors: J
authors: Mundhenk
authors: M
authors: M
authors: Germann
authors: A
authors: A
authors: Stenzl
authors: C
authors: C
authors: Schwentner
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery; D018239:Seminoma / Q000473:pathology / Q000628:therapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents