title: [Complex residual tumors after chemotherapy of nonseminomatous germ cell tumors. Laparoscopic management - limits and chances].
abstract: OBJECTIVE
  Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is often required in patients with metastatic nonseminomatous germ cell tumors (NSGCT) and residual tumors after chemotherapy. Laparoscopy has become established as a safe procedure in the surgical management of these tumors. Due to the rapid development of laparoscopy, complex retroperitoneal and even intrathoracic residuals can also be treated in high volume centers.
  
  
  METHODS
  This study included 21 retrospectively identified NSGCT and seminoma patients (mean age 29 years) with metastatic disease and clinical stage (CS) IIA-IIIB. A bilateral L-RPLND was performed in all male patients between 2009 and 2014. In 19 patients an infiltration of the great vessels was detected during surgery and vascular reconstruction was necessary. In 2 patients an intrathoracic residual 5.4 cm and 7 cm in size, respectively, was diagnosed during follow-up. Exclusion criteria for L-RPLND were positive tumor markers after chemotherapy, patients with local recurrence after previous open L-RPLND and patients with excessive vascular involvement.
  
  
  RESULTS
  In this series no conversions to open surgery were necessary. The mean tumor size post-chemotherapy was 3.6 cm (range 1.5-9.7 cm). The mean measured blood loss was 294 ml (range 50-1000 ml). The mean hospitalization time was 6 days (range 3-9 days) and mean follow-up was 16 months (range 1-37 months). No complications higher than grade II (Clavien-Dindo classification) were registered in the immediate postoperative course. During the follow-up period no in-field recurrences were registered.
  
  
  CONCLUSIONS
  The L-RPLND seems to be a safe alternative surgical procedure for certain complex residuals with vascular involvement after chemotherapy of testicular cancer. Bilateral L-RPLND is technically feasible and reproducible under guaranteed oncological principles. An infiltration of the great vessels and also intrathoracic residuals can be managed in selected patients without compromising the clinical and oncological course.
authors.affiliation: Klinik für Urologie, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Aufderklamm
authors.forename: T
authors.initials: T
authors.lastname: Todenhöfer
authors.forename: J
authors.initials: J
authors.lastname: Hennenlotter
authors.forename: J
authors.initials: J
authors.lastname: Mischinger
authors.forename: A
authors.initials: A
authors.lastname: Sim
authors.forename: J
authors.initials: J
authors.lastname: Böttge
authors.forename: S
authors.initials: S
authors.lastname: Rausch
authors.forename: S
authors.initials: S
authors.lastname: Bier
authors.forename: O
authors.initials: O
authors.lastname: Halalsheh
authors.forename: A
authors.initials: A
authors.lastname: Stenzl
authors.forename: G
authors.initials: G
authors.lastname: Gakis
authors.forename: C
authors.initials: C
authors.lastname: Schwentner
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology* / Q000628:therapy*; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents