Minimally invasive post-chemotherapy retroperitoneal lymph node dissection for nonseminoma.
BACKGROUND
We present our experience with minimally-invasive retroperitoneal lymph node dissection (MI-RPLND) in the post-chemotherapy (PC) setting for residual masses in patients with nonseminoma.


METHODS
Nineteen men who underwent PC MI-RPLND (14--laparoscopic, 5--robotic) for low-volume residual disease (no more than 5 clinically enlarged retroperitoneal masses, size < 5 cm, no adjacent organ or vascular invasion) between 2006 and 2011 were identified. Clinicodemographic information and pathological outcomes were reported.


RESULTS
Median age of our study population was 32 (interquartile range [IQR]: 28-39). Most patients presented with clinical stage II disease (63%) and were categorized as good risk (90%) by the International Germ Cell Consensus Classification. Median size of residual masses on PC imaging was 2.1 cm (IQR: 1.7-3). Full-template bilateral RPLND was completed in 53% of cases, and modified left-sided RPLND in 47%. Median operative time was 370 minutes (IQR: 320-420), and median estimated blood loss was 300 cc (IQR: 150-450). Median length of stay was 3 days (IQR: 2-3). Five patients (26%) experienced a postoperative 30 day complication, but none were higher than Clavien grade II. On final pathology, median number of lymph nodes removed was 12 (IQR: 8-23), and 8 patients (42%) had residual teratoma. No patient experienced a recurrence at median follow up of 24 months (IQR: 5-76).


CONCLUSIONS
PC MI-RPLND is a feasible option in a select group of patients with acceptable patient morbidity and short-term outcomes. Longer follow up is required to determine the oncologic efficacy of this approach.
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
Pranav
P
Sharma
Einar F
EF
Sverrisson
Kamran
K
Zargar-Shoshtari
Mayer N
MN
Fishman
Wade J
WJ
Sexton
Shohreh I
SI
Dickinson
Philippe E
PE
Spiess
Michael A
MA
Poch
Scott M
SM
Gilbert
Julio M
JM
Pow-Sang
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008297:Male; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D061646:Operative Time; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D047368:Tumor Burden
D000970:Antineoplastic Agents