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Laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ-cell tumors: current status
Robert J Hamilton1, Antonio Finelli
1Division of Urology, Department of Surgery, University of Toronto, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada.
The Urologic Clinics of North America
|May 9, 2007
Summary
Laparoscopic retroperitoneal lymph node dissection (LRPLND) is a feasible surgical technique with potentially lower morbidity than open procedures. Further research is needed to fully clarify oncologic outcomes and cost-effectiveness.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Retroperitoneal lymph node dissection (RPLND) is a standard procedure for certain cancers.
- Open RPLND is associated with significant morbidity.
- Laparoscopic retroperitoneal lymph node dissection (LRPLND) has emerged as a minimally invasive alternative.
Purpose of the Study:
- To review the literature on the technical feasibility, oncologic outcomes, morbidity, and cost-effectiveness of LRPLND.
- To compare LRPLND with traditional open RPLND.
Main Methods:
- Systematic review of published literature.
- Analysis of studies reporting on LRPLND outcomes.
Main Results:
- LRPLND is technically feasible, with several centers developing expertise.
- Morbidity associated with LRPLND appears lower than open RPLND.
- Oncologic outcomes are comparable to open RPLND, but confounding factors (e.g., adjuvant chemotherapy) exist.
- LRPLND is expected to become more cost-effective as the technique evolves.
Conclusions:
- LRPLND is a promising minimally invasive approach for retroperitoneal lymph node dissection.
- Further investigation is required to definitively establish oncologic superiority and cost-effectiveness.
- LRPLND is likely to become a preferred method with continued technique refinement.