Albers P
Klinik für Urologie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland.
Urologe A. 2012 May;51(5):687-91. doi: 10.1007/s00120-012-2888-4.
The indications to perform primary retroperitoneal lymph node dissection (RPLND) in patients with clinical stage I non-seminomatous germ cell tumors have changed. An initial surgical staging can be justified only for exceptional situations, such as a pure teratoma. Other indications can be the surgical staging and treatment of high risk patients in elective surgery. In this situation, however, only sparse data are available regarding the oncological and therapeutic effect of a minimally invasive approach compared to open surgery. Data are available on the feasibility of laparoscopically performed post-chemotherapy RPLND; however, patients for this approach must be highly selected. In general, robotic-assisted RPLND potentially offers major advantages in terms of safety and oncological efficiency compared to a classical laparoscopic approach. Especially in post-chemotherapy RPLND, the division of lumbar vessels and the control of great vessel lesions may be facilitated. However, only surgeons who are capable of handling a major vessel lesion endoscopically should consider using a robotic-assisted technique. Only patients with relatively small residual tumors without a major involvement of great vessels can be considered as candidates for robotic-assisted post-chemotherapy RPLND.
对于临床I期非精原细胞性生殖细胞肿瘤患者，进行原发性腹膜后淋巴结清扫术（RPLND）的指征已经发生了变化。仅在诸如纯畸胎瘤等特殊情况下，初始手术分期才是合理的。其他指征可以是对高风险患者进行选择性手术时的手术分期和治疗。然而，在这种情况下，与开放手术相比，关于微创方法的肿瘤学和治疗效果仅有稀少的数据。有关于腹腔镜下化疗后RPLND可行性的数据；然而，采用这种方法的患者必须经过严格筛选。一般来说，与传统腹腔镜方法相比，机器人辅助RPLND在安全性和肿瘤学效率方面可能具有主要优势。特别是在化疗后RPLND中，可能便于腰血管的分离和大血管病变的控制。然而，只有能够在内镜下处理大血管病变的外科医生才应考虑使用机器人辅助技术。只有残余肿瘤相对较小且大血管未受严重累及的患者才可以被视为机器人辅助化疗后RPLND的候选者。
