title: Bilateral laparoscopic postchemotherapy retroperitoneal lymph-node dissection in nonseminomatous germ cell tumors--a comparison to template dissection.
abstract: OBJECTIVE
  Retroperitoneal lymph node dissection (RPLND) is performed in patients with advanced nonseminomatous (NSGCT) germ cell tumors and residual retroperitoneal mass post-chemotherapy. The extent of node dissection remains unclear. Ipsilateral template dissection is a compromise between morbidity and oncological efficacy. Here, we compare ipsilateral with primary bilateral laparoscopic (L)-RPLND after chemotherapy in terms of morbidity and oncological safety.
  
  
  METHODS
  Nineteen laparoscopic ipsilateral L-RPLNDs (Group A) after platinum-based chemotherapy in patients with clinical stage IIA-III NSGCT were performed, while 20 patients underwent primary bilateral L-RPLND (Group B). We included patients with residuals localized in the retroperitoneum >1 cm and a tumor marker negativity after chemotherapy. The patients in group B had nerve sparing based on their respective tumor volume.
  
  
  RESULTS
  All L-RPLND was successfully finished without conversion. Mean operative time in group A was 221 minutes and 270 minutes in group B (p=0.12). There were no deviations from the normal postoperative course in 36 cases. There was one Grade II complication (bleomycin-induced pneumonitis) in group A and 1 grade III complication (chylous ascites) in group B. The mean hospitalization time in both groups was 5 days (p=0.1). With regard to the overall rate of disease recurrence, no significant difference was found between both groups (HR=1.84; 95% CI 0.17-39.92; p=0.6109).
  
  
  CONCLUSIONS
  Postchemotherapy L-RPLND remains technically challenging. However, the morbidity of primary bilateral post-chemotherapy L-RPLND is similar to that of template dissection. Additional oncological safety is provided, which is particularly relevant in patients with more extensive retroperitoneal tumor volume.
authors.affiliation: Department of Urology, Eberhard Karls University, Tuebingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Aufderklamm
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.forename: Jörg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: Johannes
authors.initials: J
authors.lastname: Mischinger
authors.forename: Jens
authors.initials: J
authors.lastname: Mundhenk
authors.forename: Miriam
authors.initials: M
authors.lastname: Germann
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents