Extraperitoneal laparoscopic retroperitoneal lymph node dissection after chemotherapy for nonseminomatous testicular germ-cell tumor: Surgical and oncological outcomes

Yoichi Arai, Yasuhiro Kaiho, Shigeyuki Yamada, Hideo Saito, Koji Mitsuzuka, Shinichi Yamashita, Shunichi Namiki, Haruo Nakagawa, Shigeto Ishidoya, Akihiro Ito

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Purpose: To assess the surgical and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (RPLND) after chemotherapy. Methods: Twenty patients with metastatic nonseminomatous testicular germ-cell tumor underwent extraperitoneal laparoscopic RPLND after chemotherapy. The procedure was not indicated for patients with a pre-chemotherapy mass larger than 5 cm. Morbidity and oncological outcome were reviewed retrospectively. Surgical complications were graded according to the Clavien classification system. Results: Laparoscopic RPLND was completed in all patients, and there was no conversion to open surgery. The median operating time was 223 min (range, 137-399 min). The median blood loss was 20 ml (range, 10-520 ml). There were no intraoperative complications. Postoperatively, 4 patients (20 %) had prolonged lymphorrhea (grade I) and 9 (45 %) had chyle leakage (grade I). Histological examination of the residual mass revealed necrosis in 16 (80 %) and the presence of teratoma with/without viable tumor in 4 (20 %). With a median follow-up of 45 months (range, 24-112), no patient has had disease recurrence. Normal antegrade ejaculation was preserved in all of the 14 patients studied. Conclusion: s Extraperitoneal laparoscopic RPLND can be performed with acceptable morbidity and excellent cancer control in select patients. Surgeons should be aware of relatively high incidence of chyle leakage following this procedure.

Original languageEnglish
Pages (from-to)1389-1395
Number of pages7
JournalInternational Urology and Nephrology
Volume44
Issue number5
DOIs
Publication statusPublished - 2012 Oct

Keywords

  • Chemotherapy
  • Laparoscopy
  • Retroperitoneal lymph node dissection
  • Testicular cancer

ASJC Scopus subject areas

  • Nephrology
  • Urology

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