title: Is there a limit for the laparoscopic approach of a retroperitoneal residual mass postchemotherapy?
abstract: OBJECTIVE
  Rescue lymphadenectomy for testicular cancer is a complex surgery, with a high number of complications. The laparoscopic approach appears to offer faster recovery and improved quality of life compared with open surgery. The aim of our study is to report on our experience and to define whether there is a limit (oncological, anatomical or technical) for laparoscopic management.
  
  
  METHODS
  A retrospective study was conducted of 15 patients who underwent laparoscopic retroperitoneal lymphadenectomy after chemotherapy. In addition to epidemiological and oncologic variables, we analyzed the mean surgical time, intraoperative and postoperative complications, the mean hospital stay and the mean follow-up time.
  
  
  RESULTS
  The mean surgical time was 294 minutes (range, 180-240). There were 4 large-vessel vascular lesions, all of which were large-volume retroperitoneal masses, with diameters >7 cm. The rate of postoperative complications was 33%; there was only 1 case of Clavien >III. The mean hospital stay was 5.38 days (range, 2-9), and the mean patient follow-up was 28.9 months (range, 1-79). There was no recurrence in any of the cases.
  
  
  CONCLUSIONS
  The laparoscopic approach is an oncologically safe option for the rescue treatment of testicular cancer. The complex location of these masses entails the onset of severe intraoperative complications. We have observed a clear relationship between vascular complications and large masses (>7 cm). We therefore believe that it would be appropriate to establish a limit on the size for laparoscopic treatment.
authors.affiliation: Departamento de Urología, Fundació Puigvert, Universistat Autònoma de Barcelona, Barcelona, España. Electronic address: jmgaya@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Gaya
authors.affiliation: Departamento de Urología, Fundació Puigvert, Universistat Autònoma de Barcelona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Palou
authors.affiliation: Departamento de Urología, Fundació Puigvert, Universistat Autònoma de Barcelona, Barcelona, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Peña
authors.affiliation: Departamento de Urología, Fundació Puigvert, Universistat Autònoma de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Rosales
authors.affiliation: Departamento de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Maroto
authors.affiliation: Departamento de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
authors.forename: I
authors.initials: I
authors.lastname: Sullivan
authors.affiliation: Departamento de Urología, Fundació Puigvert, Universistat Autònoma de Barcelona, Barcelona, España.
authors.forename: H
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009919:Orchiectomy; D011183:Postoperative Complications / Q000453:epidemiology; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Complicaciones; Complications; Cáncer de teste; Laparoscopia; Laparoscopy; Linfadenectomía; Lymphadenectomy; Morbidity; Morbilidad; Posquimioterapia; Postchemotherapy; Testicular cancer