TY - JOUR
T1 - Laparoscopic retroperitoneal lymph node dissection for low-stage cancer
T2 - A washington university update
AU - Gardner, Michael W.
AU - Roytman, Timur M.
AU - Chen, Cathy
AU - Brandes, Steven B.
AU - Kibel, Adam S.
AU - Grubb, Robert L.
AU - Bhayani, Sam B.
AU - Figenshau, Robert S.
PY - 2011/11/1
Y1 - 2011/11/1
N2 - Background and Purpose: At present, open retroperitoneal lymph node dissection (RPLND) remains the preferred approach at many high-volume centers for the surgical treatment of patients with low-stage testis cancer. Despite the potential advantages of a minimally invasive approach, including improved cosmesis and shorter recovery times, there remain concerns over the quality of dissection and oncologic control offered through a minimally invasive approach. Our objective was to critically evaluate the safety and intermediate-term oncologic efficacy of laparoscopic RPLND (L-RPLND). Patients and Methods: A retrospective chart review was performed, evaluating all patients who underwent L-RPLND between 2003 and 2009. Patient records were updated by telephone interview. Results: A total of 59 patients underwent L-RPLND during the study period, of which 13 had previously undergone chemotherapy. Mean age at treatment was 32 years. Mean operative time and estimated blood loss were 291 minutes (176-620 min) and 184 mL (range 0-1800 mL), respectively. Mean lymph node count was 21.6 (range 5-48). Mean hospital stay was 2 days (range 1-4 d). There were three open conversions because of intraoperative complications. One patient needed a transfusion. Five patients had six (8.5%) postoperative complications: three lymphoceles, two chylous ascites, and one deep venous thrombosis/pulmonary embolus. Of 18 patients with node-positive pathology, 13 received adjuvant chemotherapy and 5 underwent surveillance. Retroperitoneal recurrence did not develop in any patient undergoing surveillance during a mean follow-up of 21.3 months. One postchemotherapy RPLND (1.7%) patient experienced a retroperitoneal recurrence. Conclusions: L-RPLND is a diagnostic and therapeutic treatment option for patients with low-stage testis cancer, offering excellent oncologic control and acceptable perioperative morbidity. Intermediate-term results suggest that L-RPLND is a viable alternative to the open surgical procedure. Carefully selected patients may be candidates for L-RPLND in the postchemotherapy setting.
AB - Background and Purpose: At present, open retroperitoneal lymph node dissection (RPLND) remains the preferred approach at many high-volume centers for the surgical treatment of patients with low-stage testis cancer. Despite the potential advantages of a minimally invasive approach, including improved cosmesis and shorter recovery times, there remain concerns over the quality of dissection and oncologic control offered through a minimally invasive approach. Our objective was to critically evaluate the safety and intermediate-term oncologic efficacy of laparoscopic RPLND (L-RPLND). Patients and Methods: A retrospective chart review was performed, evaluating all patients who underwent L-RPLND between 2003 and 2009. Patient records were updated by telephone interview. Results: A total of 59 patients underwent L-RPLND during the study period, of which 13 had previously undergone chemotherapy. Mean age at treatment was 32 years. Mean operative time and estimated blood loss were 291 minutes (176-620 min) and 184 mL (range 0-1800 mL), respectively. Mean lymph node count was 21.6 (range 5-48). Mean hospital stay was 2 days (range 1-4 d). There were three open conversions because of intraoperative complications. One patient needed a transfusion. Five patients had six (8.5%) postoperative complications: three lymphoceles, two chylous ascites, and one deep venous thrombosis/pulmonary embolus. Of 18 patients with node-positive pathology, 13 received adjuvant chemotherapy and 5 underwent surveillance. Retroperitoneal recurrence did not develop in any patient undergoing surveillance during a mean follow-up of 21.3 months. One postchemotherapy RPLND (1.7%) patient experienced a retroperitoneal recurrence. Conclusions: L-RPLND is a diagnostic and therapeutic treatment option for patients with low-stage testis cancer, offering excellent oncologic control and acceptable perioperative morbidity. Intermediate-term results suggest that L-RPLND is a viable alternative to the open surgical procedure. Carefully selected patients may be candidates for L-RPLND in the postchemotherapy setting.
UR - http://www.scopus.com/inward/record.url?scp=80855147805&partnerID=8YFLogxK
U2 - 10.1089/end.2010.0596
DO - 10.1089/end.2010.0596
M3 - Article
C2 - 21936630
AN - SCOPUS:80855147805
SN - 0892-7790
VL - 25
SP - 1753
EP - 1757
JO - Journal of Endourology
JF - Journal of Endourology
IS - 11
ER -