Post-Chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ-Cell Testicular Tumors

ABSTRACT Introduction Retroperitoneal lymph node dissection (RPLND) is performed to treat residual disease following chemotherapy for stage II and III testicular cancer. Significant morbidity can be associated with open RPLND. As such, laparoscopic techniques have been demonstrated to be safe and effective in select cases. Outcomes following post-chemotherapy laparoscopic RPLND for mixed malignant germ-cell testicular tumors (MMGCT) are limited in the literature. Methods We performed retrospective chart review for patients who underwent laparoscopic RPLND at our institution for MMGCT from May 2006 to October 2016. Patient clinical data, perioperative and oncologic outcomes were recorded. Results Twenty-three patients underwent post-chemotherapy laparoscopic RPLND. Thirty-five percent (8/23) underwent bilateral template dissection, while 65% (15/23) underwent a modified unilateral template dissection. Robotic assistance was utilized in 22% (5/23) of cases. Bilateral template was inferior to unilateral template RPLND in operative time, estimated blood loss, open conversion rate, length of hospital stay, and complication rate. Mean follow up was 35.1 months and 43.3 months for the bilateral and unilateral template groups, respectively. Mean lymph node yield and recurrence rate were similar between the two cohorts. One recurrence of mature teratoma was noted 67 months after unilateral laparoscopic RPLND. Conclusions In select patients, laparoscopic RPLND for stage II and III MMGCT is safe and effective in the post-chemotherapy setting. Bilateral template laparoscopic RPLND was associated with inferior perioperative outcomes, but similar oncologic outcomes compared to unilateral template. Patients requiring bilateral template RPLND should be considered for an open approach.