Open Access

ARTICLE

Minimally invasive post-chemotherapy retroperitoneal lymph node dissection for nonseminoma

Pranav Sharma^1,*, Einar F. Sverrisson^2,*, Kamran Zargar-Shoshtari¹, Mayer N. Fishman¹, Wade J. Sexton¹, Shohreh I. Dickinson³, Philippe E. Spiess¹, Michael A. Poch¹, Scott M. Gilbert¹, Julio M. Pow-Sang¹

1 Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
2 Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
3 Departments of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
* denotes equal contribution
Address correspondence to Dr. Julio M. Pow-Sang, Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612 USA

Canadian Journal of Urology 2015, 22(4), 7882-7889.

Abstract

Introduction: We present our experience with minimally-invasive retroperitoneal lymph node dissection (MI-RPLND) in the post-chemotherapy (PC) setting for residual masses in patients with nonseminoma.
Materials and methods: Nineteen men who underwent PC MI-RPLND (14 – laparoscopic, 5 – robotic) for low-volume residual disease (no more than 5 clinically enlarged retroperitoneal masses, size < 5 cm, no adjacent organ or vascular invasion) between 2006 and 2011 were identified. Clinicodemographic information and pathological outcomes were reported.
Results: Median age of our study population was 32 (interquartile range [IQR]: 28-39). Most patients presented with clinical stage II disease (63%) and were categorized as good risk (90%) by the International Germ Cell Consensus Classification. Median size of residual masses on PC imaging was 2.1 cm (IQR: 1.7-3). Full-template bilateral RPLND was completed in 53% of cases, and modified left-sided RPLND in 47%. Median operative time was 370 minutes (IQR: 320-420), and median estimated blood loss was 300 cc (IQR: 150-450). Median length of stay was 3 days (IQR: 2-3). Five patients (26%) experienced a postoperative 30 day complication, but none were higher than Clavien grade II. On final pathology, median number of lymph nodes removed was 12 (IQR: 8-23), and 8 patients (42%) had residual teratoma. No patient experienced a recurrence at median follow up of 24 months (IQR: 5-76).
Conclusions: PC MI-RPLND is a feasible option in a select group of patients with acceptable patient morbidity and short-term outcomes. Longer follow up is required to determine the oncologic efficacy of this approach.

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