Laparoscopic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Tumors Current Status

Robert J. Hamilton, MD, MPHa, Antonio Finelli, MD, MSc, FRCSCb*

aDivision of Urology, Department of Surgery, University of Toronto, c/o University Health Network, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9 bDivision of Urology, Department of Surgical Oncology, University Health Network, Princess Margaret Hospital. 610 University Avenue, 3-130, Toronto, Ontario, Canada M5G 2M9

The multimodal management of testis cancer has yielded impressive cure rates. Together, the use of accurate tumor markers, refined surgical techniques, highly effective cis-platinum-based chemotherapeutic regimens, and in the case of seminoma, radiation therapy, have brought the overall survival for this disease to greater than 90%.

Similar to the ongoing evolution of other extirpative procedures in genitourinary oncology, the introduction of technology and minimally invasive surgery has been a driving force. Since the first description of a laparoscopic approach to retroperitoneal lymph node dissection in 1992, its use has become more prevalent [1]. Yet, unlike laparoscopic nephrectomy, laparoscopic retroperitoneal lymph node dissection (LRPLND) has met considerable opposition and thus has not been widely accepted. Supporters of LRPLND refer to reduced morbidity, length of stay, time to return to normal activity, and equivalent oncologic outcome data. Those in opposition argue that oncologic equivalency has not yet been proven, the dissection is not as complete as the conventional approach, and it takes longer with greater monetary cost.

Herein, we address the current and future role of LRPLND. We review the published literature

* Corresponding author.

E-mail address: [email protected] (A. Finelli).

regarding the technical feasibility of a laparoscopic approach, the oncologic outcomes, the associated morbidity, and the cost-effectiveness of LRPLND.

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