Laparoscopic Lymph Node Resection of Post-Chemotherapy (POST-CHT) Residual Retroperitoneal (RP) Tumor Masses in Patients with Non-Seminomatous Testicular Germ-Cell Tumors (NSTGCT)

ABSTRACT Introduction Resection of post-CHT residual masses, usually located in retroperitoneum, is an essential part of the management of NSTGCT. Presently, surgical procedure consists in an open unilateral retroperitoneal lymph node dissection (RPLND) of a modified template. Laparoscopic procedures have reduced morbidity compared to open surgery; in addition, limited lymphadenectomies or resection of essentially the residual mass may help to reduce morbidity, although it might have a higher incidence of local relapses. Objective To analyze relapse rate, morbidity and toxicity associated to laparoscopic RPLND in a series of patients (pts) with NSTGCT of a single tertiary referral center with surgeons who have extensive experience in post-CHT resection between January 2002 and January 2012. Results Retrospective analysis of 14 pts with a median follow-up of 40 months (m). Median age at diagnosis was 30 (18-43) years. Pathologic evaluation of the testis tumor revealed mixed NSTGCT with teratomatous elements in 11/14, and pure teratoma in 1. Embryonal carcinoma was presented in 12/14. Royal Marsden staging classification was: IIA: 2; IIB: 7; IIC: 2; IIIB: 1; IVB: 1, IVC: 1. All pts received a median of 4 cycles of BEP and had a complete serum marker response after induction CHT. RP masses showed a partial response in 8 and stable disease in 6 pts. Median size of the post-CHT retroperitoneum masses was 2,5 cm (1-10). Histologic examination showed fibrosis or necrosis in 4 (28%) and mature teratoma in 10 (64%) pts. Toxicity: Median days of hospitalization were 4 (2-9). 5 pts showed decrease of at least 2 points in hemoglobin, not requiring transfusion support. Chylous ascites was reported in 1 and an infected RP hematoma in another 1 pts. 2 pts developed ejaculatory dysfunction. Only 1 patient experienced an early relapse (3 m after RPLND) requiring salvage laparotomy. Pathology of the RP mass in this case reported a growing teratoma. All pts are alive and presently free of disease. Conclusion In our series, in a Hospital with long expertise in RP surgery, laparoscopic RPLND provided a low rate of complications and RP relapses, reducing morbidity comparing to historical series with open procedures. Disclosure All authors have declared no conflicts of interest.