Eleven-Year Experience With Midline Extraperitoneal Retroperitoneal Lymph Node Dissection for Germ Cell Tumors

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• The midline extraperitoneal approach for retroperitoneal lymph node dissection (EP-RPLND) is a surgical technique used in the management of germ cell tumors (GCTs).
• This approach has been suggested to have lower morbidity compared to the traditional transperitoneal method.

Purpose of the Study:

• To review an 11-year institutional experience with the midline extraperitoneal approach for retroperitoneal lymph node dissection (EP-RPLND) in patients diagnosed with germ cell tumors (GCTs).
• To evaluate the safety, perioperative outcomes, and oncologic efficacy of this surgical technique.

Main Methods:

• A retrospective review of all patients with GCT who underwent EP-RPLND between 2010 and 2021 was conducted.
• Surgical, perioperative, and oncologic outcomes were analyzed. Logistic regression was used to identify predictors of early discharge. Recurrence-free survival (RFS) and recurrence patterns were assessed.

Main Results:

• A total of 237 patients underwent EP-RPLND, with 72% in the postchemotherapy setting. Median hospital stay was 2 days, with 89% discharged by postoperative day 2. Complication rates were low (4% grade III-IV).
• Two-year RFS rates were high for both primary and postchemotherapy settings, ranging from 0.85 to 0.93 depending on GCT subtype. In-field recurrence was observed in only 7 patients.

Conclusions:

• Midline EP-RPLND is a safe surgical procedure for GCT patients, characterized by rapid gastrointestinal recovery and short hospital stays.
• The technique demonstrates favorable oncologic outcomes, including low recurrence rates, in both primary and postchemotherapy settings.