Laparoscopic Retroperitoneal Lymph Node Dissection with Therapeutic Intent in Men with Clinical Stage I Nonseminomatous Germ Cell Tumors

Background and Purpose: Laparoscopic retroperitoneal lymph node dissection (RPLND) as a primary means of therapy for patients with clinical stage I nonseminomatous germ-cell tumors (NSGCTs) remains controversial. The object of this study was to assess the outcomes of patients with clinical stage I NSGCTs who underwent laparoscopic RPLND with therapeutic intent. Patients and Methods: We retrospectively reviewed the pathologic and clinical outcomes of 26 consecutive patients who underwent a laparoscopic RPLND with therapeutic intent for clinical stage I NSGCT from July 2006 to March 2009. Patients underwent an extended template laparoscopic RPLND including dissection behind the great vessels. A full bilateral dissection was performed if metastatic disease was discovered intraoperatively. Results: Of the 26 patients, 9 (35%) were discovered to have pathologic stage II disease. The mean number of nodes removed at the time of laparoscopic RPLND was 28 (range 6-82). Of six patients found to have pN(1) disease, four (67%) did not receive adjuvant chemotherapy and are without evidence of disease at a mean follow-up of 24 months. Two (12%) patients with pathologically confirmed stage I disease had recurrence after laparoscopic RPLND, both outside of the retroperitoneum. Conclusion: Laparoscopic RPLND with therapeutic intent can be performed with acceptable oncologic efficacy with the additional benefit of decreased morbidity and shorter convalescence times. Early data suggest that patients with pathologic N(1) disease can be safely observed after laparoscopic RPLND, although longer follow-up and additional patients are needed to validate these results.