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Review
. 2023 Jan 10;59(1):133.
doi: 10.3390/medicina59010133.

Twenty Years' Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center

Angelo Mottaran  1   2 , Amelio Ercolino  1   2 , Lorenzo Bianchi  1   2 , Pietro Piazza  1   2 , Francesco Manes  1   2 , Sasan Amirhassankhani  1   2 , Marco Salvador  1   2 , Francesco Chessa  1   2 , Beniamino Corcioni  1   3 , Alessandro Bertaccini  1   2 , Riccardo Schiavina  1   2 , Eugenio Brunocilla  1   2
Affiliations
Review

Twenty Years' Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center

Angelo Mottaran et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56-180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.

Keywords: RPLND; open approach; primary setting; retroperitoneal lymph node dissection; secondary setting; surgical volume; testicular cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria.
Figure 2
Figure 2
Overall and mixed distribution of testicular cancer histotypes at post-orchiectomy pathology.
Figure 3
Figure 3
Overall and mixed distribution of testicular cancer histotypes at post-RPLND pathology.
Figure 4
Figure 4
Bilateral RPLND template with inferior mesenteric artery dissection.
Figure 5
Figure 5
Radical nephrectomy during retroperitoneal lymph node dissection.
Figure 6
Figure 6
Kaplan–Meier Curve for Overall Survival (A) and Recurrence-Free Survival (B) of patients with testicular cancer and submitted to RPLND.
Figure 7
Figure 7
Kaplan–Meier with log-rank test for comparison of Overall Survival (A) and Recurrence-Free Survival (B) between primary and secondary RPLND subgroups patients.
See this image and copyright information in PMC

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Supplementary concepts