Extraperitoneal laparoscopic retroperitoneal lymph node dissection after chemotherapy for nonseminomatous testicular germ-cell tumor: surgical and oncological outcomes
Extraperitoneal laparoscopic retroperitoneal lymph node dissection after chemotherapy for nonseminomatous testicular germ-cell tumor: surgical and oncological outcomes
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非精原性睾丸生殖细胞肿瘤化疗后腹膜外腹腔镜腹膜后淋巴结清扫术：手术和肿瘤学结果
DOI：
10.1007/s11255-012-0195-z
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发表时间：
2012
影响因子：
2
通讯作者：
A. Ito
中科院分区：
文献类型：
--
作者：
Y. Arai;Y. Kaiho;S. Yamada;H. Saito;K. Mitsuzuka;S. Yamashita;S. Namiki;H. Nakagawa;S. Ishidoya;A. Ito
目的评价化疗后腹腔镜腹膜后淋巴结清扫术（RPLND）的手术及肿瘤预后。方法20例转移性非半细胞性睾丸生殖细胞瘤患者化疗后行腹腔外腹腔镜RPLND。该手术不适用于化疗前肿块大于5厘米的患者。回顾性回顾发病率和肿瘤预后。手术并发症按照Clavien分类系统进行分级。结果所有患者均完成腹腔镜下RPLND手术，无中转开腹手术。手术时间中位数为223 min（范围137-399 min）。中位失血量为20毫升（范围10-520毫升）。无术中并发症。术后4例（20%）患者出现延长性淋巴漏（I级），9例（45%）患者出现乳糜漏（I级）。残余肿块的组织学检查显示16例（80%）坏死，4例（20%）存在畸胎瘤伴/无存活肿瘤。中位随访45个月（范围24-112），无患者复发。14例患者均保持正常的顺行射精。结论经腹腔腹腔镜RPLND治疗的患者发病率可接受，肿瘤控制良好。外科医生应该意识到这种手术后乳糜漏的发生率相对较高。
PurposeTo assess the surgical and oncological outcomes of laparoscopic retroperitoneal lymph node dissection (RPLND) after chemotherapy.MethodsTwenty patients with metastatic nonseminomatous testicular germ-cell tumor underwent extraperitoneal laparoscopic RPLND after chemotherapy. The procedure was not indicated for patients with a pre-chemotherapy mass larger than 5 cm. Morbidity and oncological outcome were reviewed retrospectively. Surgical complications were graded according to the Clavien classification system.ResultsLaparoscopic RPLND was completed in all patients, and there was no conversion to open surgery. The median operating time was 223 min (range, 137–399 min). The median blood loss was 20 ml (range, 10–520 ml). There were no intraoperative complications. Postoperatively, 4 patients (20 %) had prolonged lymphorrhea (grade I) and 9 (45 %) had chyle leakage (grade I). Histological examination of the residual mass revealed necrosis in 16 (80 %) and the presence of teratoma with/without viable tumor in 4 (20 %). With a median follow-up of 45 months (range, 24–112), no patient has had disease recurrence. Normal antegrade ejaculation was preserved in all of the 14 patients studied.ConclusionsExtraperitoneal laparoscopic RPLND can be performed with acceptable morbidity and excellent cancer control in select patients. Surgeons should be aware of relatively high incidence of chyle leakage following this procedure.