Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer – a single center analysis

BMC Urology

Research Article

Kurt Miller¹  Stefan Hinz¹  Barbara Erber¹  Ahmed Magheli¹  Jonas Busch¹  Ivan Hoffmann¹  Carsten Kempkensteffen¹  Steffen Weikert¹  Frank Friedersdorff¹  Mark Schrader¹ 

[1] Department of Urology, From the Charité University Medicine Berlin, Berlin, Germany;

关键词: Advanced testicular cancer;    Postchemotherapy;    Retroperitoneal lymph node dissection;    Laparoscopy;    Metastasis;   

DOI  :  10.1186/1471-2490-12-15

 received in 2011-12-28, accepted in 2012-05-31,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe open approach represents the gold standard for postchemotherapy retroperitoneal lymph node dissection (O-PCLND) in patients with residual testicular cancer. We analyzed laparoscopic postchemotherapy retroperitoneal lymph node dissection (L-PCLND) and O-PCLND at our institution.MethodsPatients underwent either L-PCLND (n = 43) or O-PCLND (n = 24). Categorical and continuous variables were compared using the Fisher exact test and Mann–Whitney U test respectively. Overall survival was evaluated with the log-rank test.ResultsPrimary histology was embryonal cell carcinomas (18 patients), pure seminoma (2 cases) and mixed NSGCTs (47 patients). According to the IGCCCG patients were categorized into “good”, “intermediate” and “poor prognosis” disease in 55.2%, 14.9% and 20.8%, respectively. Median operative time for L-PCLND was 212 min and 232 min for O-PCLND (p = 0.256). Median postoperative duration of drainage and hospital stay was shorter after L-PCLND (0.0 vs. 3.5 days; p < 0.001 and 6.0 vs. 11.5 days; p = 0.002). Intraoperative complications occurred in 21.7% (L-PCLND) and 38.0% (O-PCLND) of cases with 19.5% and 28.5% of Clavien Grade III complications for L-PCLND and O-PCLND, respectively (p = 0.224). Significant blood loss (>500 ml) was almost equally distributed (8.6% vs. 14.2%: p = 0.076). No significant differences were observed for injuries of major vessels and postoperative complications (p = 0.758; p = 0.370). Tumor recurrence occurred in 8.6% following L-PCLND and in 14.2% following O-PCLND with a mean disease-free survival of 76.6 and 89.2 months, respectively. Overall survival was 83.3 and 95.0 months for L-PCNLD and O-PCLND, respectively (p = 0.447).ConclusionsL-PCLND represents a safe surgical option for well selected patients at an experienced center.

【 授权许可】

Unknown   
© Busch et al.; licensee BioMed Central Ltd 2012. This article is published under license to BioMed Central Ltd. .This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.