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

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

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. CONCLUSIONS 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.