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Published on: February 12, 2022
Laparoscopic retroperitoneal lymph node dissection with therapeutic intent in men with clinical stage I
Thomas J Guzzo1, Mark L Gonzalgo, Mohamad E Allaf
1The James Buchanan Brady Urologic Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. tguzzo1@jhmi.edu
Background And Purpose:
Laparoscopic retroperitoneal lymph node dissection (RPLND) as a primary means of therapy for patients with clinical stage I nonseminomatous germ-cell tumors (NSGCTs) remains controversial. The object of this study was to assess the outcomes of patients with clinical stage I NSGCTs who underwent laparoscopic RPLND with therapeutic intent.
Patients And Methods:
We retrospectively reviewed the pathologic and clinical outcomes of 26 consecutive patients who underwent a laparoscopic RPLND with therapeutic intent for clinical stage I NSGCT from July 2006 to March 2009. Patients underwent an extended template laparoscopic RPLND including dissection behind the great vessels. A full bilateral dissection was performed if metastatic disease was discovered intraoperatively.
Results:
Of the 26 patients, 9 (35%) were discovered to have pathologic stage II disease. The mean number of nodes removed at the time of laparoscopic RPLND was 28 (range 6-82). Of six patients found to have pN₁ disease, four (67%) did not receive adjuvant chemotherapy and are without evidence of disease at a mean follow-up of 24 months. Two (12%) patients with pathologically confirmed stage I disease had recurrence after laparoscopic RPLND, both outside of the retroperitoneum.
Conclusion:
Laparoscopic RPLND with therapeutic intent can be performed with acceptable oncologic efficacy with the additional benefit of decreased morbidity and shorter convalescence times. Early data suggest that patients with pathologic N₁ disease can be safely observed after laparoscopic RPLND, although longer follow-up and additional patients are needed to validate these results.
Insights
Laparoscopic retroperitoneal lymph node dissection (RPLND) offers effective treatment for clinical stage I nonseminomatous germ-cell tumors (NSGCTs), with reduced morbidity. Early results suggest observation may be suitable for some patients with pathologic N1 disease.
Area of Science:
- Urology
- Surgical Oncology
- Oncology
Background:
- Controversy exists regarding laparoscopic retroperitoneal lymph node dissection (RPLND) as primary therapy for clinical stage I nonseminomatous germ-cell tumors (NSGCTs).
- Assessing outcomes of laparoscopic RPLND for clinical stage I NSGCTs is crucial for treatment planning.
Purpose of the Study:
- To evaluate the oncologic efficacy and safety of laparoscopic RPLND performed with therapeutic intent in patients with clinical stage I NSGCTs.
- To determine the outcomes, including recurrence rates and morbidity, associated with this surgical approach.
Main Methods:
- Retrospective review of 26 patients undergoing laparoscopic RPLND for clinical stage I NSGCT between July 2006 and March 2009.
- Inclusion of extended template dissection, including behind great vessels, and full bilateral dissection if intraoperative metastases were found.
Main Results:
- 35% of patients (9/26) had pathologic stage II disease.
- A mean of 28 lymph nodes were removed.
- Two patients (12%) with pathologically confirmed stage I disease experienced recurrence outside the retroperitoneum.
Conclusions:
- Laparoscopic RPLND can achieve acceptable oncologic outcomes with reduced morbidity and faster recovery.
- Observation may be a safe option for patients with pathologic N1 disease, though further research is needed.