Long-Term Results of Laparoscopic Retroperitoneal Lymph-Node Dissection for Clinical Stage I Nonseminomatous Germ-Cell Testicular Cancer

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Abstract
Purpose: To report the long-term oncologic outcome and morbidity of laparoscopic retroperitoneal lymph-node dissection (L-RPLND) in clinical stage I nonseminomatous testicular germ-cell tumors (NSGCT) from a single institution. Patients and Methods: From August 1992 to May 2005, 136 patients with clinical stage I disease underwent L-RPLND. The mean follow-up was 68 months (range 8–151 months). Patient selection was not based on histologic findings or the presence of risk factors. Lymphadenectomy was performed within the boundaries described by Weissbach and Boedefeld. Results: The laparoscopic procedure could be completed in 129 patients (94.9%). Seven required conversion to open surgery. The median blood loss was 50 mL (range 20–3000 mL), and the mean operative time was 261 minutes (range 115–570 minutes). There were no perioperative deaths. The mean postoperative hospital stay was 4.1 days. Antegrade ejaculation was preserved in all patients. In the series, 25 patients (18.4%) had pathologic stage IIA disease and received adjuvant chemotherapy consisting of two cycles of cisplatin, etoposide, and bleomycin; none of these patients has relapsed. Eight patients (5.9%) suffered relapses, although L-RPLND had yielded negative lymph nodes in all of them. All eight patients were salvaged with cisplatin-based chemotherapy, with surgery also performed in two patients. All other patients (N = 128, 94.1%) remained relapse free. None of the patients died because of tumor progression. Conclusions: The L-RPLND has proved to be an excellent staging tool, which should be developed into a less-invasive alternative to primary open RPLND. The oncologic outcome of L-RPLND without adjuvant chemotherapy in pathologic stage II disease is being investigated.

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