LAPAROSCOPIC RETROPERITONEAL LYMPHADENECTOMY FOR HIGH-RISK STAGE-1 NONSEMINOMATOUS GERM-CELL TUMOR - REPORT OF 4 CASES

Objective. To evaluate in a prospective fashion the feasibility of performing retroperitoneal lymphadenectomy (RPL) for high-risk Stage 1 nonseminomatous germ cell tumors (NSGCT) using a laparoscopic technique, and to compare the results to historical controls. Methods. RPL was performed laparoscopically on patients with Stage 1 NSGCT. Each patient had pathologic risk factors associated with an increased likelihood of metastases, and radiologic investigations revealed no evidence of retroperitoneal or distant disease. A modified template lymphadenectomy was performed in each case. The results of these four operations were compared to eight open RPLs performed on a similar group of patients. Results. In 3 of the 4 cases, a thorough dissection was possible. In 1 of these 3, an open laparotomy was required to repair a caval laceration resulting from avulsion of a small lumbar vein at the end of the laparoscopic dissection. Compared to the open approach, there was considerably less postoperative morbidity. Conclusions. This procedure may represent an alternative approach to surveillance or open RPL for high-risk Stage 1 patients. Further experience is required to determine the sensitivity and effectiveness of this procedure compared to open RPL before its role in clinical practice can be established.