Laparoscopic Retroperitoneal Lymph-Node Dissection in the Management of Clinical Stage I and II Testicular Cancer

Abstract

Laparoscopic retroperitoneal lymph-node dissection (RPLND) has been advocated for and utilized in the management of testicular cancer. In this overview, we present our technique and results in comparison with the worldwide experience with laparoscopic RPLND in the management of clinical stage I and II cancers. Over the last 13 years, 162 patients with testicular cancer clinical stage I (N = 103) or II (N = 43 IIB, 16 IIC) underwent laparoscopic RPLND. All intraoperative and postoperative data were evaluated, as well as the worldwide experience with the procedure. With a mean follow-up of 62 months (range 6-113 months) for clinical stage I and 53 months (range 10-89 months) for clinical stage II, oncologic efficiency was evaluated. The procedure was feasible even after chemotherapy, with only three conversions to open RPLND in clinical stage I. The mean operative time was 217, 216, and 281 minutes for clinical stages I, IIB, and IIC, respectively. The mean blood loss was 144 mL and 165 mL for clinical stage I and II, respectively. The hospital stays were 3.6 and 3.8 days, respectively. During follow-up, we had two retroperitoneal relapses (1.2%) and four distant relapses (2.5%). Laparoscopic RPLND has demonstrated its surgical and oncologic efficacy. The morbidity and the complication rate are low. Recurrence rates are comparable to those of open surgery. Laparoscopic RPLND is safe, with less postoperative morbidity, quicker convalescence, better cosmetic results, and a diagnostic accuracy equal that of the open technique.