Is there a limit for the laparoscopic approach of a retroperitoneal residual mass postchemotherapy?

Abstract Objectives Rescue lymphadenectomy for testicular cancer is a complex surgery, with a high number of complications. The laparoscopic approach appears to offer faster recovery and improved quality of life compared with open surgery. The aim of our study is to report on our experience and to d...

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Published in:Actas urológicas españolas (English ed.) 2015-05, Vol.39 (4), p.264-267
Main Authors: Gaya, J.M, Palou, J, Peña, J.A, Rosales, A, Maroto, P, Sullivan, I, Villavicencio, H
Format: Article
Language:English
Subjects:
Complicaciones
Complications
Cáncer de teste
Laparoscopia
Laparoscopy
Linfadenectomía
Lymphadenectomy
Morbidity
Morbilidad
Posquimioterapia
Postchemotherapy
Testicular cancer
Urology
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Summary:Abstract Objectives Rescue lymphadenectomy for testicular cancer is a complex surgery, with a high number of complications. The laparoscopic approach appears to offer faster recovery and improved quality of life compared with open surgery. The aim of our study is to report on our experience and to define whether there is a limit (oncological, anatomical or technical) for laparoscopic management. Materials and methods A retrospective study was conducted that included 15 patients who underwent laparoscopic retroperitoneal lymphadenectomy after chemotherapy. In addition to epidemiological and oncologic variables, we analyzed the mean surgical time, intraoperative and postoperative complications, the mean hospital stay and the mean follow-up time. Results The mean surgical time was 294 min (range, 180–240). There were 4 large-vessel vascular lesions, and all of which were large-volume retroperitoneal masses, with diameters >7 cm. The rate of postoperative complications was 33%; there was only 1 case of Clavien > III . The mean hospital stay was 5.38 days (range, 2–9), and the mean patient follow-up was 28.9 months (range, 1–79). There was no recurrence in any of the cases. Conclusions The laparoscopic approach is an oncologically safe option for the rescue treatment of testicular cancer. The complex location of these masses entails the onset of severe intraoperative complications. We have observed a clear relationship between vascular complications and large masses (>7 cm). We therefore believe that it would be appropriate to establish a limit on the size for laparoscopic treatment.
ISSN:2173-5786
2173-5786
DOI:10.1016/j.acuroe.2015.03.013