Laparoscopic retroperitoneal lymph node dissection for stage I and II nonseminomatous germ-cell tumors

Abstract

Objectives: Open retroperitoneal lymph node dissection has been traditionally used for the management of patients with nonseminomatous germ-cell tumors (NSGCTs). Over the last decade, laparoscopic retroperitoneal lymph node dissection (LRPLND) has gained popularity in several highly specialized centers.

Methods: We retrospectively reviewed the English-language literature with regard to LRPLND. The perioperative and oncologic outcomes for patients with low stage NSGCTs who underwent LRPLND are summarized in this review with particular emphasis on contemporary studies.

Results: Initially only used for staging, LRPLND has evolved to a therapeutic procedure capable of replicating the templates used for open RPLND. Perioperative outcomes including operative time, conversion rates and complications improve with surgeon experience and are acceptable at high volume centers. Oncologic outcomes are promising, but require longer term follow-up and the administration of adjuvant chemotherapy in many studies limits comparison to that of the open technique.

Conclusion: LRPLND has been demonstrated to be feasible and safe at large volume institutions with experienced laparoscopic surgeons. LRPLND was originally performed as a staging procedure in patients with NSGCTs but has evolved into a therapeutic operation with early reports demonstrating short hospital stays and minimal morbidity. Further studies in larger cohorts of patients with longer term follow up are required to define the exact role of LRPLND.

Keywords: laparoscopic retroperitoneal lymph node dissection; testicular cancer.

Figure 1

LRPLND is performed with patient supine on operating room table and both arms tucked. Supine positioning allows for easy conversion to full bilateral LRPLND when warranted.

Figure 2

Portion of right template LRPLND illustrating renal hilum superiorly, right ureter laterally and inferior vena cava medially.

Figure 3

Interaortocaval lymph node dissection, with transection of lumbar vein to allow access to retrocaval nodes.

Figure 4

Portion of left-sided nerve sparing template illustrating preserved sympathetic nerve fibers, renal hilum superiorly, left ureter laterally and aorta medially.