The impressive cure rate associated with conventional RPLND is difficult to improve upon. Furthermore, contemporary series document diminished morbidity as compared with that historically associated with the procedure. However, there are clearly patients who do not require such aggressive intervention. Yet with current imaging and other prognostic modalities, a subset of patients will be understaged and consequently managed conservatively when they could have benefited from retroperitoneal dissection.

Hence, LRPLND was introduced to provide a sensitive and specific staging modality without the morbidity of conventional RPLND. With proof that it is technically feasible, several centers have become experts in this technique and morbidity appears to be less than that of open RPLND. As experience builds, operative times diminish, and patients are discharged from hospital earlier. Thus, it is likely that LRPLND will become equally if not more cost-effective than conventional RPLND. However, the oncologic outcomes, while on par with open RPLND series, are difficult to attribute to successful LRPLND alone when nearly all patients with positive nodes received chemotherapy. We must await follow-up of the rare patients who opted not to have adjuvant chemotherapy after LRPLND or look to new studies assessing the efficacy of LRPLND alone. Although uncertainties exist, LRPLND holds much future promise.

0 0

Post a comment