Laparoscopic retroperitoneal, lymphadenectomy after chemotherapy for stageIIB nonseminomatous testicular carcinoma

Purpose: We investigated laparoscopic retroperitoneal lymphadenectomy after chemotherapy for stage IIB testicular carcinoma in terms of operative feas ibility, overall morbidity and tumor control. Materials and Methods: Between February 1995 and April 1998, 24 patients un derwent laparoscopic retroperitoneal lymphadenectomy following initial chem otherapy for stage IIB (2 to 5 cm.) solitary or unilateral lymph node metas tases. Mean tumor diameter was 2.4 cm. before and 1.1 cm. after chemotherap y. Laparoscopic retroperitoneal lymphadenectomy was performed in all patien ts, including those with complete remission. Results: Laparoscopic retroperitoneal lymphadenectomy could be completed as planned in all patients and there was no need for conversion to open surge ry. Operative time was 150 to 300 minutes (mean 240). Blood loss was minima l and no blood transfusions were required. The only postoperative complicat ions were chylous ascites ( 5 patients) which resolved with conservative ma nagement (low fat diet) and a small asymptomatic lymphocele. Histological e xamination revealed necrosis in 71%, mature teratoma in 25% and active tumo r in 4% of patients. Antegrade ejaculation was preserved in all patients. M ean postoperative hospital stay was 4 days, return to normal activities bet ween 1 and 3 weeks, and time to complete recovery between 5 and 10 weeks. A ll patients were well without evidence of disease at a mean followup of 24. 4 months. Conclusions: Laparoscopic retroperitoneal lymphadenectomy after chemotherap y proved feasible in select patients presenting with solitary or unilateral lymph node metastases and was associated with a low morbidity. Tumor contr ol was not compromised by the laparoscopic approach.