Testis Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Department of Mathematics, MOX-Milano Politecnico, Milan, Italy.
J Urol. 2018 Mar;199(3):741-747. doi: 10.1016/j.juro.2017.09.088. Epub 2017 Sep 28.
The prognosis of stage I nonseminomatous germ cell tumor of the testis is favorable. Early and late side effects of treatment may affect quality of life and survival. We determined the tolerability, safety and efficacy of laparoscopic retroperitoneal lymph node dissection in patients with stage I nonseminomatous germ cell tumor of the testis at a high volume center.
Unilateral laparoscopic retroperitoneal lymph node dissection was prospectively recorded in 225 patients from 2000 to 2014. Since 2007, patients have been treated at a multidisciplinary clinic and were proposed surgery as an alternative to surveillance or adjuvant chemotherapy. The indication for adjuvant chemotherapy changed during the study period. Descriptive statistics and regression analyses were used to evaluate the domains of safety and oncologic outcomes.
A total of 221 patients were evaluable. Median operative time was 200 minutes. Conversion to open surgery was done in 20 cases (9%). A median of 14 nodes (IQR 11-20) was retrieved. Grade greater than 2 complications in 8 cases (3.6%) increased as the number of retrieved nodes increased. Antegrade ejaculation was maintained in 98.6% of patients. Nodal metastases were found in 29 patients (13%), of whom 7 underwent adjuvant chemotherapy. There were 14 recurrences (6.3%), including 8 of 192 (4.2%) associated with no nodal metastases and 6 of 22 (27.3%) associated with nodal metastases in patients not undergoing adjuvant chemotherapy. At regression analyses lymph node ratio was the only significant factor predictive of recurrence and of the administration of any chemotherapy (each p <0.001). Operative time, the number of retrieved nodes and conversions improved with time.
In the context of a high volume center laparoscopic retroperitoneal lymph node dissection was safe and its oncologic efficacy was comparable to that of open surgery. Select patients with stage I nonseminomatous germ cell tumor could be offered laparoscopic retroperitoneal lymph node dissection as an alternative to other options.
睾丸 I 期非精原细胞瘤生殖细胞肿瘤的预后良好。治疗的早期和晚期副作用可能会影响生活质量和生存。我们在一家高容量中心确定了腹腔镜腹膜后淋巴结清扫术在睾丸 I 期非精原细胞瘤生殖细胞肿瘤患者中的耐受性、安全性和疗效。
从 2000 年到 2014 年，前瞻性地记录了 225 例单侧腹腔镜腹膜后淋巴结清扫术。自 2007 年以来，患者在多学科诊所接受治疗，并提出手术作为替代监测或辅助化疗的方法。在研究期间，辅助化疗的适应证发生了变化。采用描述性统计和回归分析评估安全性和肿瘤学结果的各个领域。
共 221 例患者可评估。中位手术时间为 200 分钟。20 例（9%）转为开放手术。中位数为 14 个节点（IQR 11-20）。随着所取节点数量的增加，8 例（3.6%）出现大于 2 级的并发症。98.6%的患者保持顺行射精。29 例（13%）患者发现淋巴结转移，其中 7 例接受辅助化疗。有 14 例复发（6.3%），其中 8 例（4.2%）与无淋巴结转移相关，6 例（27.3%）与未接受辅助化疗的患者的淋巴结转移相关。在回归分析中，淋巴结比率是预测复发和任何化疗的唯一显著因素（均为 p <0.001）。手术时间、所取节点数量和转换随着时间的推移而改善。
在高容量中心，腹腔镜腹膜后淋巴结清扫术是安全的，其肿瘤学疗效与开放手术相当。可以为选择的 I 期非精原细胞瘤生殖细胞肿瘤患者提供腹腔镜腹膜后淋巴结清扫术作为替代其他选择。
