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Laparoscopic retroperitoneal lymph node dissection for high-risk pediatric patients with paratesticular
Jeffrey J Tomaszewski1, Danielle D Sweeney, Louis R Kavoussi
1Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. tomaszewskijj@upmc.edu
Insights
Laparoscopic retroperitoneal lymph node dissection (LRPLND) is a safe procedure for high-risk pediatric paratesticular rhabdomyosarcoma. This approach allows for rapid recovery and timely adjuvant chemotherapy initiation.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Retroperitoneal lymph node dissection (RPLND) is indicated for pediatric paratesticular rhabdomyosarcoma (PTRMS) in patients aged 10+.
- Tumor size >5 cm in PTRMS increases retroperitoneal recurrence risk.
- This study evaluates laparoscopic RPLND (LRPLND) in high-risk pediatric PTRMS.
Observation:
- Three pediatric patients (mean age 13.6 years) with large PTRMS (mean 7.5 cm) underwent modified template LRPLND.
- LRPLND was performed a mean of 8.6 days post-orchiectomy.
- Average operative time was 382 minutes with minimal blood loss (mean 53 mL).
Findings:
- No postoperative complications were observed.
- Microscopic disease was found in one of three patients' retroperitoneal nodes.
- Mean postoperative hospital stay was 2.5 days.
Implications:
- LRPLND is a safe and effective diagnostic and therapeutic option for high-risk pediatric PTRMS.
- The procedure facilitates rapid convalescence, enabling prompt initiation of adjuvant chemotherapy.
- LRPLND may improve outcomes for pediatric patients with PTRMS.
Background And Purpose:
Retroperitoneal lymph node dissection (RPLND) is recommended in children 10 years or older with paratesticular rhabdomyosarcoma (PTRMS). Primary tumors >5 cm are an additional risk factor for disease recurrence in the retroperitoneum. We report our experience with laparoscopic RPLND (LRPLND) in high-risk pediatric patients with PTRMS.
Patients And Methods:
Three patients, mean age 13.6 years (range 10-16 yrs), underwent modified template LRPLND after radical orchiectomy for preoperative rhabdomyosarcoma stage T(1a)N(0)M(0), T(1b)N(0)M(0), and T(2b)N(0)M(0), respectively. Primary paratesticular masses measured a mean 7.5 cm (range 4-10 cm). LRPLND was performed a mean of 8.6 days (range 7-12 d) after radical orchiectomy using four trocars that were placed equidistant in the midline.
Results:
Average operative time was 382 minutes (range 245-656 minutes). Mean estimated blood loss was 53 mL (range 10-75 mL), and mean postoperative hospital stay was 2.5 days (range 2-3 d). There were no postoperative complications. Retroperitoneal nodes had negative findings for microscopic disease in two patients and positive findings in one patient. All patients received adjuvant chemotherapy with vincristine, actinomycin, and cyclophosphamide.
Conclusion:
LRPLND for high-risk pediatric patients with PTRMS is a safe diagnostic and therapeutic procedure with the benefit of rapid convalescence, enabling early commencement of adjuvant chemotherapy.