title: Laparoscopic Postchemotherapy Retroperitoneal Lymph-Node Dissection Can Be a Standard Option in Defined Nonseminomatous Germ Cell Tumor Patients.
abstract: Residual retroperitoneal masses in NSGCT need postchemotherapy retroperitoneal lymph-node dissection (PC-RPLND). Open (O) PC-RPLND is a standardized procedure, but morbidity is not negligible and mostly attributable to laparotomy. Laparoscopic (L) PC-RPLND may improve tolerability profile. We evaluated viability, toxicity, and short to medium-term oncologic outcome of L-PC-RPLND following well-defined selection criteria.
  
  
  
  Since February 2011, consecutive patients with a unilateral residual mass (≥1 cm or growing), normalized markers, and limited encasement of inferior vena cava and/or aorta were candidate to unilateral L-PC-RPLND. Surgical performances, histology, hospital stay, complications within 30 days, and survival were recorded. Patients were regularly followed up. Adjuvant chemotherapy was not provided.
  
  
  
  Sixty-seven patients (stage IIA = 14; IIB = 41; IIC = 7; III = 5), representing 29% of all those candidate to PC-RPLND in this time frame, underwent L-PC-RPLND up to August 2015. Median size of the mass was 27 mm (interquartile range [IQR] 15-31). Median operative time was 234 minutes (IQR 184-250). Three procedures were converted to open surgery. Mean hospital stay was 3 days (IQR 2-4). Out of three (4.5%), one grade III (lymphocele requiring drainage) complication occurred. Sixty-six (98.5%) patients maintained antegrade ejaculation. Histology revealed teratoma in 76%, fibronecrotic tissue in 21%, and viable cancer in 3% patients. All patients are alive and event free after a median follow-up of 21 months (IQR 10-30).
  
  
  
  In a referral center, L-PC-RPLND is a transferable option for a proportion of patients with a residual mass. Tolerability is acceptable, and current oncologic outcome is consistent with a safe oncologic profile.
authors.affiliation: 1 Testis Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .|2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Francesco
authors.initials: F
authors.lastname: Cattaneo
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Davide
authors.initials: D
authors.lastname: Biasoni
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Mario
authors.initials: M
authors.lastname: Catanzaro
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Tullio
authors.initials: T
authors.lastname: Torelli
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Michele
authors.initials: M
authors.lastname: Zazzara
authors.affiliation: 3 Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: 3 Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giannatempo
authors.affiliation: 3 Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Daniele
authors.initials: D
authors.lastname: Raggi
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Luigi
authors.initials: L
authors.lastname: Piva
authors.affiliation: 4 Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Maurizio
authors.initials: M
authors.lastname: Colecchia
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvioni
authors.affiliation: 2 Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy .
authors.forename: Silvia
authors.initials: S
authors.lastname: Stagni
mesh_terms: D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008210:Lymphocele / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000601:surgery*; D061646:Operative Time; D011184:Postoperative Period; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: germ cell and embryonal; laparoscopy; lymph node excision; neoplasms; retroperitoneal lymph-node dissection; testicular neoplasms