Laparoscopic retroperitoneal lymph node dissection in testicular cancer: feasibility and safety at a tertiary center.

OBJECTIVE

To bear the evidence that laparoscopy is the possible new treatment of choice in the management of retroperitoneal disease in patients with testicular cancer. The surgical management of retroperitoneal lymph nodes is a crucial step in the multidisciplinary treatment of testicular germ cell tumors. Laparoscopic retroperitoneal approach poses technical challenges in urologic oncology. This study reports on the safety, efficacy, and short-term oncological outcomes of laparoscopic retroperitoneal lymph node dissection at a tertiary referral hospital.

METHOD: Prospective, observational, descriptive study conducted from 2021 to 2023, including 83 patients who underwent laparoscopic retroperitoneal lymph node dissection.

RESULTS

Eleven cases of primary laparoscopic retroperitoneal lymph node dissection (13.3%), 36 standard (43.3%), 22 salvage (26.5%), 11 desperation (13.3%), and 3 redo cases (3.6%) were performed. In primary cases, 81.9% of patients had positive nodes (pN1-3). The conversion rate to open surgery was 6%. Bleeding, lymph node volume, pre-lymphadenectomy markers, chemotherapy, initial histology, and lymph node histology were not risk factors for conversion = Mean surgical time was 250 minutes. There were no major complications (organ injury, vascular injury) or need for blood transfusion = Mean blood loss was 60 mL. Recurrence rate was 9.6%, with recurrence-free survival of 36.7 months.

CONCLUSIONS

The reported experience demonstrated the safety and efficacy of primary laparoscopic retroperitoneal lymph node dissection, as well as post-chemotherapy cases. Laparoscopic approach allows for early patient recovery without compromising oncological outcomes. It is advisable to perform this surgery in high-volume centers with experienced surgeons in retroperitoneal surgery.