title: Trans- and extraperitoneal retroperitoneal lymph node dissection (RPLND) in the treatment for nonseminomatous germ cell testicular tumors (NSGCT): a single Chinese center's retrospective analysis.
abstract: OBJECTIVE
  To evaluate the role of two different approaches to perform laparoscopic RPLND: transperitoneal laparoscopic retroperitoneal lymph node dissection (TL-RPLND) and extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RPLND).
  
  
  METHODS
  Between February 2003 and April 2013, 39 patients with nonseminomatous germ cell testicular tumors were treated by RPLND in our center. Twenty-one patients had TL-RPLND, and 18 patients had EL-RPLND. We performed a comprehensive retrospective study comparing TL-RPLND and EL-RPLND. Certain parameters, including operative time, estimated blood loss, perioperative complications, resected lymph nodes, postoperative intestinal function recovery time, ejaculation, and postoperative tumor markers, were abstracted and compared.
  
  
  RESULTS
  In the EL-RPLND and TL-RPLND groups, the operation times were 178 ± 31 and 207 ± 25 min; the amounts of estimated blood loss were 87 ± 26 and 111 ± 21 ml; the postoperative intestinal function recovery times were 1.2 ± 0.7 and 2.4 ± 0.6 days; the postoperative hospital stays were 5.8 ± 1.1 and 5.5 ± 1.4 days; and the numbers of resected lymph nodes were 16.2 ± 1.5 and 15.8 ± 1.6, respectively. No conversion from laparoscopic to open surgery occurred. No patient in either group received an intraoperative blood transfusion. Overall, two patients developed postoperative fever, and one developed abdominal distension. After a median follow-up of 45 months, no regional relapse or metastases occurred, but 4 patients at clinical stage II were treated successfully by three cycles of platinum-based postoperative chemotherapy. Currently, all patients show no evidence of disease.
  
  
  CONCLUSIONS
  Our results demonstrate that EL-RPLND was superior to the transperitoneal approach in terms of the operation time, estimated blood loss, and postoperative intestinal function recovery time, whereas no differences were observed in the number of lymph nodes resected. EL-RPLND was demonstrated to be safe and feasible, with satisfactory clinical outcomes when performed by experienced laparoscopic surgeons. Larger cohorts of patients with longer term follow-up are needed for further studies to determine the role of different approaches to L-RPLND.
authors.affiliation: Department of Urology, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
authors.forename: Shiyu
authors.initials: S
authors.lastname: Tong
authors.forename: Minfeng
authors.initials: M
authors.lastname: Chen
authors.forename: Xiongbing
authors.initials: X
authors.lastname: Zu
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.forename: Ye
authors.initials: Y
authors.lastname: Lei
authors.forename: Wentao
authors.initials: W
authors.lastname: Liu
authors.forename: Lin
authors.initials: L
authors.lastname: Qi
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D017024:Chemotherapy, Adjuvant; D002681:China; D005334:Fever / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D061646:Operative Time; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult