2008 Annual Meeting Abstracts
Laparoscopic Retroperitoneal Lymph Node Dissection with Therapeutic Intent: Perioperative Outcomes and Early Oncological Results
Mohamad E Allaf, Thomas J Guzzo, Carolyn M Senger*, Mark L Gonzalgo
Johns Hopkins, Baltimore, MD
Introduction:
Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is emerging as an alternative for the management of clinical stage I non-seminomatous germ cell tumors (NSGCT). While initially performed for staging purposes, L-RPLND has evolved into an operation with therapeutic intent aiming to duplicate the open approach. We present early perioperative and oncological outcomes.
Methods:
Between December 2006 and April 2008, 11 men with clinical stage I NSGCT underwent L-RPLND using a modified template. A bilateral dissection was performed if frozen section confirmed disease in the retroperitoneum. Perioperative and postoperative records were reviewed.
Results:
The mean age in this cohort was 33 years and 9 men had right sided tumors. The proportion of patients harboring a predominant embryonal component, teratoma, or having lymphovascular invasion in the primary tumor was 64%, 55%, and 64% respectively. The mean blood loss, OR time, and length of stay was 125cc, 215 minutes, and 2 days. The mean number of lymph nodes retrieved was 19. Of the 8 men found to have pN0 disease, 1 has recurred in the chest 8 months following surgery. Of the 2 patients with pN1 disease, neither has received chemotherapy and both are free of recurrence at 6months. The 1 patient with pN2 disease received chemotherapy 2 weeks postoperatively and is recurrence free at 10 months. There have been no retroperitoneal recurrences or complications.
Conclusions: : L-RPLND with therapeutic intent is safe, and oncologically sound with short follow-up. Longer follow-up and larger cohorts are needed to confirm its oncological durability.
