LAPAROSCOPIC RETROPERITONEAL LYMPHADENECTOMY - MULTIINSTITUTIONAL ANALYSIS

Modified unilateral laparoscopic retroperitoneal lymph node dissection was attempted in 20 patients with nonseminomatous testicular cancer. The procedure was completed in 18 men at a median operative length of 6 hours. Median estimated blood loss was 250 cc and median number of l ymph nodes removed was 14.5. Nodal disease spread was noted in 3 of 18 patients (17%). Most patients were hospitalized for 3 days or less an d had returned to normal activity levels within 2 to 3 weeks. Antegrad e ejaculation was preserved in all 20 patients. Significant complicati ons occurred in 6 of 20 patients (30%), with bleeding being the most c ommon adverse event encountered. In 2 patients an abdominal incision a nd completion of the procedure by open retroperitoneal lymph node diss ection were required due to significant bleeding following injury to t he gonadal vessels. With a median followup of 10 months (range 2 to 25 ), 2 men had pulmonary disease recurrence and none had abdominal recur rence. Laparoscopic retroperitoneal lymph node dissection can be compl eted successfully in patients with stage I testicular cancer and may b e most appropriate in those with limited risk of metastatic disease sp read. The morbidity may be largely attributed to a steep learning curv e. The efficacy of laparoscopic retroperitoneal lymph node dissection compared with standard techniques and determination of its role in pat ients with testicular cancer will require longer followup in larger gr oups of patients.