Laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors: long-term oncologic outcomes

Laparoscopic retroperitoneal lymph node dissection was first described in 1992, and has become more commonly practiced at certain centers. Laparoscopic retroperitoneal lymph node dissection may be less morbid than open retroperitoneal lymph node dissection, but more costly. Controversy exists, however, regarding the oncologic adequacy of the procedure. The published literature regarding the oncologic outcomes of laparoscopic retroperitoneal lymph node dissection is reviewed herein.

Laparoscopic retroperitoneal lymph node dissection has not been as widely adopted as other laparoscopic procedures for genitourinary malignancy. There have only been seven publications in the last 3 years, often coming from the same centers. Recently there has been a change in practice with a greater effort to perform therapeutic laparoscopic retroperitoneal lymph node dissection and not simply a staging procedure. Adjuvant chemotherapy is no longer routinely offered to all patients with positive nodes.

The impressive cure rate and decreasing morbidity associated with conventional open retroperitoneal lymph node dissection are difficult to improve upon. While on par with open retroperitoneal lymph node dissection series, the current oncologic outcomes are difficult to attribute to successful laparoscopic retroperitoneal lymph node dissection alone. Most patients with viable tumor in the retroperitoneal lymph node dissection specimen received chemotherapy. Thus, we must await follow-up of the patients who declined adjuvant chemotherapy after laparoscopic retroperitoneal lymph node dissection or the results of more recent initiatives with laparoscopic retroperitoneal lymph node dissection alone.