Efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer

Abstract

Objective To evaluate of efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer. Methods From January 2001 to September 2014, 83 patients with primary testicular nonseminomatous germ cell tumors (NSGCT) received nerve sparing LRPLND at 1-4 week after orchiectomy.Their age ranged from 18 to 44 years old, mean 25 years old.Serum AFP was abnormally elevated in 51 patients, ranged from 15to 1432μg/L (mean 874 μg/L). beta-HCG were abnormally elevated in 46 patients, ranged from 5-70 IU/L(mean 56 IU/L). All of their clinical stage was stage Ⅰ and did not suffer from ejaculatory dysfunction.The operating time, intraoperative blood loss, postoperative intestinal function recovery time, drainage removal time, hospital stay, intra - and post - operative complications were recorded. Results The nerve sparing laparoscopic retroperitoneal lymph was successfully performed in all patients.The mean operating time was 218 min, (range 158-285 min). The mean intraoperative blood loss was 368ml (range 255-587ml). The postoperative intestinal function recovery time ranged from 24 to 48 hours (mean 31 hours). And the hospital stay ranged from 5 to 9 days (mean 7days). The inferior vena cava was injured during operation and was sutured laparoscopically in 1 patient.Mild chylous retroperitoneal drainage was seen in 3 patients, which was cured within 1 week after operation by restriction of high - fat diet.22 cases were noticed ejaculation dysfunction postoperatively, which recovered spontaneously within 8 to 12 weeks.Within the 3 to 76 months follow - up, 73 patients revealed no evidence of recurrence or distant metastasis. Conclusions Nerve sparing LRPLND is technically feasible, mini invasive, the morbidity and complication were significantly lower.It can be performed with satisfactory results in young patients with early stage NSGCT. Key words: Testicle; Nonseminomatous germ cell tumors; Nerve sparing retroperitoneal lymph node dissection; Laparoscopy; Ejaculation