title: Postchemotherapy laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors infiltrating the great vessels.
abstract: OBJECTIVE
  Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is an alternative in patients with metastatic nonseminomatous germcell tumors (NSGCT) necessitating resection of residuals postchemotherapy. With the advancement of laparoscopic vascular surgery, prospective management of the great vessels has become feasible and safe. We present our experience with L-RPLND in NSGCT residuals with significant vascular involvement necessitating intracorporeal reconstruction.
  
  
  METHODS
  We have retrospectively identified 19 NSGCT patients (mean age 27 years) who presented with residuals postchemotherapy. A bilateral L-RPLND was performed in all men. Infiltration of the great vessels was confirmed intraoperatively. Prospective vascular control and temporary clamping was performed in all cases. The vessel wall was reconstructed using vascular surgery techniques. All patients had at least clinical stages of IIA or higher. Follow-up was obtained in all.
  
  
  RESULTS
  There were no conversions to open surgery. The mean size of the residuals after chemotherapy was 3.87 cm (1.5-9.7 cm). The mean blood loss was 310 mL (50-1000 mL). Mean hospital stay was 6 days (3-9 days). There were no perioperative complications exceeding grade II according to the Clavien-Dindo classification. Distant or in-field recurrence (mean observational period 18 months) did not develop in any patient.
  
  
  CONCLUSIONS
  Laparoscopic RPLND may be considered a safe alternative concept for the management of post-chemotherapy NSGCT residuals involving the great vessels. Bilateral L-RPLND in patients with vascular infiltration is feasible and reproducible when laparoscopic vascular surgery can be reliably handled. All standard principles of open surgery are respected, and initial oncologic results are promising.
authors.affiliation: Department of Urology, Eberhard Karls University , Tübingen, Germany .
authors.forename: Stefan
authors.initials: S
authors.lastname: Aufderklamm
authors.forename: Tilman
authors.initials: T
authors.lastname: Todenhöfer
authors.forename: Joerg
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: Johannes
authors.initials: J
authors.lastname: Mischinger
authors.forename: Johannes
authors.initials: J
authors.lastname: Böttge
authors.forename: Steffen
authors.initials: S
authors.lastname: Rausch
authors.forename: Omar
authors.initials: O
authors.lastname: Halalsheh
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.forename: Georgios
authors.initials: G
authors.lastname: Gakis
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
mesh_terms: D000328:Adult; D001011:Aorta / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000601:surgery; D014684:Venae Cavae / Q000473:pathology / Q000601:surgery*