Laparoscopic lumbar-aortic lymphadenectomy in residual post-chemotherapy tumors in testicular cancer

Abstract Introduction Open lumbar-aortic lymphadenectomy (OLAL) is the gold standard for treating post-chemotherapy retroperitoneal masses. Laparoscopic OLAL (L-OLAL) has emerged in recent years as an alternative for the handling of patients with these masses, with the additional potential benefits of minimal invasion. Objective To present our experience with the laparoscopic handling (L-OLAL) of residual post-chemotherapy masses in patients with advanced testicular cancer. Materials and methods Between 1993 and 2009, 43 patients underwent post-chemotherapy L-OLAL. A transperitoneal technique was employed in all patients. We assessed demographic, perioperational and pathological variables, as well as complications and follow-up. Results A unilateral dissection was performed in 17 patients, while 26 patients underwent a bilateral retroperitoneal dissection. In the first group, 4 patients relapsed. In the second group, there were no relapses. After an average follow-up of 21 months, the overall survival rate reached 95%. We recorded a rate of perioperative complications of only 9.3%. Conclusions In experienced hands, L-OLAL is a technically feasible surgical alternative for the treatment of patients who are carriers of advanced testicular cancer with residual post-chemotherapy masses. The dissection performed should be bilateral to avoid tumor relapses and increase the survival rate of these patients.