Bilateral laparoscopic postchemotherapy retroperitoneal lymph-node dissection in nonseminomatous germ cell tumors--a comparison to template dissection.

PURPOSE: Retroperitoneal lymph node dissection (RPLND) is performed in patients with advanced nonseminomatous (NSGCT) germ cell tumors and residual retroperitoneal mass post-chemotherapy. The extent of node dissection remains unclear. Ipsilateral template dissection is a compromise between morbidity and oncological efficacy. Here, we compare ipsilateral with primary bilateral laparoscopic (L)-RPLND after chemotherapy in terms of morbidity and oncological safety.

PATIENTS AND METHODS: Nineteen laparoscopic ipsilateral L-RPLNDs (Group A) after platinum-based chemotherapy in patients with clinical stage IIA-III NSGCT were performed, while 20 patients underwent primary bilateral L-RPLND (Group B). We included patients with residuals localized in the retroperitoneum >1 cm and a tumor marker negativity after chemotherapy. The patients in group B had nerve sparing based on their respective tumor volume.

RESULTS: All L-RPLND was successfully finished without conversion. Mean operative time in group A was 221 minutes and 270 minutes in group B (p=0.12). There were no deviations from the normal postoperative course in 36 cases. There was one Grade II complication (bleomycin-induced pneumonitis) in group A and 1 grade III complication (chylous ascites) in group B. The mean hospitalization time in both groups was 5 days (p=0.1). With regard to the overall rate of disease recurrence, no significant difference was found between both groups (HR=1.84; 95% CI 0.17-39.92; p=0.6109).

CONCLUSIONS: Postchemotherapy L-RPLND remains technically challenging. However, the morbidity of primary bilateral post-chemotherapy L-RPLND is similar to that of template dissection. Additional oncological safety is provided, which is particularly relevant in patients with more extensive retroperitoneal tumor volume.