title: Quality of life and pain control following laparoscopic retroperitoneal lymph node dissection in early-stage nonseminoma.
abstract: OBJECTIVE
  To evaluate postoperative pain (PoP) and quality of life (QoL) in patients undergoing open (O-) or laparoscopic (L-) retroperitoneal lymph node dissection (RPLND) for clinical stage I (CS I) and normal markers CS IIA nonseminomatous germ cell tumors.
  
  
  METHODS
  Since March 2010, a prospective nonrandomized trial evaluated dynamic and rest (R) numeric pain scale (NPS) following patient-controlled analgesia and baseline (T0), 3-month (T3), and 6-month (T6) QoL status assessed by Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire and the Italian-validated Functional Assessment of Chronic Illness Therapy (FACT-T-SG) at T6. Secondary endpoints included length of hospital stay (LHS), interval to recovery (ItR), complications, and oncologic outcomes.
  
  
  RESULTS
  In March 2012, 69 (64 CS I) patients were enrolled. Five patients only chose O-RPLND. The PoP and complete QoL data are available in 41 and 56 patients, respectively. The R-NPS significantly improved in days 1-2 vs day 0 (p&lt;0.0008). The FACT-G scores improved from baseline: the emotional well-being scale was the most relevant at T3 (+7.0, p = 0.0001) and T6 (+6.9, p = 0.0002). The FACT-TS-G indicated high satisfaction levels. Median LHS and ItR were 3 and 15 days. Six complications required an intervention. Nodal metastases were found in 14 (20.3%) patients. Following a median follow-up of 36 months, 6 (8.9%) patients relapsed (2/12 among pN+), and 8 patients (11.9%) underwent chemotherapy. All patients maintained antegrade ejaculation and are alive and disease-free.
  
  
  CONCLUSIONS
  Almost all patients chose L-RPLND, which is associated with a rapid improvement of postoperative pain; QoL scores improved up to 6 months. The L-RPLND may be considered as an alternative only when performed in highly experienced centers.
authors.affiliation: Testis Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.|Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.affiliation: Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bianchi
authors.affiliation: Anesthesiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Donati
authors.affiliation: Anesthesiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: L'Acqua
authors.affiliation: Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Brunelli
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Biasoni
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Catanzaro
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stagni
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Piva
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Torelli
authors.affiliation: Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Raggi
authors.affiliation: Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giannatempo
authors.affiliation: Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Faré
authors.affiliation: Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Colecchia
authors.affiliation: Anesthesiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
authors.affiliation: Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Borreani
authors.affiliation: Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvioni
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008210:Lymphocele / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000601:surgery*; D059408:Pain Management; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery*