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Laparoscopic retroperitoneal lymph node dissection in testicular cancer: feasibility and safety at a tertiary center
Anna Scavuzzo1, Iván Calvo-Vázquez1, Nancy Reynoso-Noveron2
1Departamento de Urología.
Objective:
To bear the evidence that laparoscopy is the possible new treatment of choice in the management of retroperitoneal disease in patients with testicular cancer. The surgical management of retroperitoneal lymph nodes is a crucial step in the multidisciplinary treatment of testicular germ cell tumors. Laparoscopic retroperitoneal approach poses technical challenges in urologic oncology. This study reports on the safety, efficacy, and short-term oncological outcomes of laparoscopic retroperitoneal lymph node dissection at a tertiary referral hospital.
Method:
Prospective, observational, descriptive study conducted from 2021 to 2023, including 83 patients who underwent laparoscopic retroperitoneal lymph node dissection.
Results:
Eleven cases of primary laparoscopic retroperitoneal lymph node dissection (13.3%), 36 standard (43.3%), 22 salvage (26.5%), 11 desperation (13.3%), and 3 redo cases (3.6%) were performed. In primary cases, 81.9% of patients had positive nodes (pN1-3). The conversion rate to open surgery was 6%. Bleeding, lymph node volume, pre-lymphadenectomy markers, chemotherapy, initial histology, and lymph node histology were not risk factors for conversion = Mean surgical time was 250 minutes. There were no major complications (organ injury, vascular injury) or need for blood transfusion = Mean blood loss was 60 mL. Recurrence rate was 9.6%, with recurrence-free survival of 36.7 months.
Conclusions:
The reported experience demonstrated the safety and efficacy of primary laparoscopic retroperitoneal lymph node dissection, as well as post-chemotherapy cases. Laparoscopic approach allows for early patient recovery without compromising oncological outcomes. It is advisable to perform this surgery in high-volume centers with experienced surgeons in retroperitoneal surgery.
Insights
Laparoscopic retroperitoneal lymph node dissection is a safe and effective treatment for testicular cancer patients, offering early recovery without compromising oncological outcomes. High-volume centers with experienced surgeons are recommended for optimal results.
Area of Science:
- Urologic Oncology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Retroperitoneal lymph node dissection is critical in managing testicular cancer.
- Laparoscopic techniques present unique challenges in urologic oncology.
Purpose of the Study:
- To evaluate the safety, efficacy, and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (LRPND).
- To establish LRPND as a potential treatment of choice for retroperitoneal disease in testicular cancer.
Main Methods:
- Prospective observational study of 83 patients undergoing LRPND from 2021-2023.
- Data collected on primary, standard, salvage, desperation, and redo LRPND cases.
Main Results:
- Low conversion rate (6%) to open surgery, with no identified risk factors for conversion.
- Mean surgical time of 250 minutes, minimal blood loss (60 mL), and no major complications or transfusions.
- 9.6% recurrence rate with a recurrence-free survival of 36.7 months.
Conclusions:
- LRPND is safe and effective for both primary and post-chemotherapy testicular cancer cases.
- The laparoscopic approach facilitates faster patient recovery without negatively impacting oncological results.
- This procedure should be performed in high-volume centers by experienced retroperitoneal surgeons.
