Post-chemotherapy nerve-sparing laparoscopic retroperitoneal lymph node dissection in stage IIB testicular cancer

We report our experience of extraperitoneal nerve-sparing laparoscopic retroperitoneal lymph node dissection after chemotherapy. Six patients were diagnosed with non-seminomatous germ cell tumor after orchiectomy and clinical stage IIB disease. Nerve-sparing laparoscopic retroperitoneal lymph node dissection was carried out for residual retroperitoneal tumors after cisplatin-based chemotherapy. The median tumor diameter was 2.95 cm before chemotherapy and 1.95 cm after chemotherapy. A modified left (n=1), right (n=1) and bilateral (n=4) template for the dissection area was used. Surgery was successfully completed in all patients and no conversion to open surgery was necessary. Median operative time was 394 min (range 212-526 min). Median blood loss was 75 mL (range 10-238 mL). The overall complication rate was 33.3% (2/6). Two patients had prolonged lymphatic leakage (grade I), which was managed conservatively. Antegrade ejaculation was preserved in all six patients. The histopathological findings showed that two patients had mature teratoma and four patients had necrotic tissue. After a median follow up of 30 months (range 24-36), no recurrence of disease was observed. We can conclude that extraperitoneal nerve-sparing laparoscopic retroperitoneal lymph node dissection for residual tumors after chemotherapy is a feasible operation. The oncological outcomes need to be confirmed in a certain number of patients with longer follow up.