Laparoscopic retroperitoneal lymph-node dissection in metastatic nonseminomatous germ-cell tumors.

Abstract

OBJECTIVES:

To support laparoscopic post-chemotherapy retroperitoneal lymph-node dissection (L-PC-RPLND) as a potential new standard, we report on a large dataset of patients systematically undergoing L-PC-RPLND.

PATIENTS AND METHODS:

Patients with unilateral residual mass (≥1 cm), normalized markers, limited encasement (<30%) of gross retroperitoneal vessels underwent unilateral L-PC-RPLND with no adjuvant chemotherapy. Surgical performances, histology, hospital stay, complications within 30 days and follow-up visits were recorded. Multivariable linear and logistic regression models were used.

RESULTS:

Between February 2011 and January 2021, 151 consecutive patients underwent L-PC-RPLND. Median size of the residual mass was 25 mm (interquartile range [IQR] 20-35 mm). Overall median operative time was 208 min (IQR 177-241) and was 51 min longer (p-value <0.001) for right L-PC-RPLNDs. Eleven procedures were converted to open surgery. Median number of removed and positive nodes was 11 (IQR 8-16) and 1 (IQR 1-2), respectively. Mean hospital stay was 2 days (IQR 2-3). Nine complications (6%) occurred: two were Clavien-Dindo grade III. Definitive pathology revealed post-pubertal teratoma in 65.6%, fibro-necrotic tissue in 23.8%, teratoma with malignant somatic component in 6.6% and viable tumour in 4.0% patients. In multivariable linear regression models, fibro-necrotic tissue (32 min, CI 8.5-55.5; p < 0.01) and residual volume (1.05 min, CI 0.24-1.85; p < 0.01) achieved independent predictor status for longer operative time. All patients, but one, are alive and disease-free after a median follow-up of 22 months (IQR 10, 48).

CONCLUSION:

L-PC-RPLND, when adequately planned, is safe and effective for most patients with low to medium volume residual masses.

• Authors: Sebastiano Nazzani, Silvia Stagni, Davide Biasoni, Mario Catanzaro, Alberto Macchi, Antonio Tesone, Tullio Torelli, Ruggero Darisi, Vito Lo Russo, Claudia Colbacchini, Rodolfo Lanocita, Tommaso Cascella, Melanie Claps, Patrizia Giannatempo, Matteo Zimatore, Laura Cattaneo, Emanuele Montanari, Roberto Salvioni, Nicola Nicolai
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 49 Issue 1 Pg. 257-262 (01 2023) ISSN: 1532-2157 [Electronic] England
• PMID: 36031470 (Publication Type: Journal Article)
• Copyright: Copyright © 2022. Published by Elsevier Ltd.

Topics

• Male
• Humans
• Retrospective Studies
• Lymph Node Excision (methods)
• Neoplasms, Germ Cell and Embryonal (surgery)
• Teratoma (surgery)
• Testicular Neoplasms (surgery, pathology)
• Retroperitoneal Space (surgery)
• Laparoscopy (methods)
• Treatment Outcome