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Complications of laparoscopic retroperitoneal lymph node dissection in testicular cancer

World Journal of Urology Aims and scope Submit manuscript

Abstract

Objectives

A proposed benefit of laparoscopic retroperitoneal lymph node dissection (LRPLND) is more favorable morbidity in comparison to open retroperitoneal lymph node dissection (RPLND). The objective of this review is to examine and summarize the literature regarding complications in both primary and post-chemotherapy LRPLND (PC-LRPLND) and, where appropriate, we include the opinions of the senior author regarding management.

Methods

A MEDLINE search was performed using the terms “laparoscopy” or “laparoscopic,” “retroperitoneal lymph node dissection” or “RPLND,” and “testicular neoplasms.” Articles were included on the basis of study design and content. For series updated over time, an effort was made to include only the most recent data to avoid duplicate reporting of patients.

Results

In primary LRPLND, vascular injury is the most common complication, occurring in 2.2–20% of reported cases. Bowel injury is rarely reported but potentially catastrophic. Rates of retrograde ejaculation are less than 5%. Chylous ascites and lymphocele are delayed post-operative complications. Rarely reported complications include nerve injury, retroperitoneal hematoma, and ureteral injury requiring internal stent placement.

PC-LRPLND is challenging, with high rates of conversion and complications. Hemorrhage is common. Retrograde ejaculation is several-fold more common in PC-LRPLND than in primary LRPLND. No peri-operative mortality has been reported for either LRPLND or PC-LRPLND.

Conclusions

LRPLND and PC-LRPLND are technically demanding. Hemorrhage and vascular injury are the most commonly reported complications. Prospective studies will help clarify the proposed benefits of LRPLND.

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References

  1. Rukstalis DB, Chodak GW (1992) Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol 148(6):1907–1909

    PubMed  CAS  Google Scholar 

  2. Albqami N, Janetschek G (2005) Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol 19(6):683–692

    Article  PubMed  Google Scholar 

  3. Hamilton RJ, Finelli A (2007) Laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ-cell tumors: current status. Urol Clin North Am 34(2):159–169

    Article  PubMed  Google Scholar 

  4. Neyer M, Peschel R, Akkad T, Springer-Stohr B, Berger A, Bartsch G, Steiner H (2007) Long-term results of laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testicular cancer. J Endourol 21(2):180–183

    Article  PubMed  Google Scholar 

  5. Bhayani SB, Ong A, Oh WK, Kantoff PW, Kavoussi LR (2003) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer: a long-term update. Urology 62(2):324–327

    Article  PubMed  Google Scholar 

  6. Carver BS, Sheinfeld J (2005) The current status of laparoscopic retroperitoneal lymph node dissection for non-seminomatous germ-cell tumors. Nat Clin Pract Urol 2(7):330–335

    Article  PubMed  Google Scholar 

  7. Abdel-Aziz KF, Anderson JK, Svatek R, Marqulis V, Saqalowsky AI, Cadeddu JA (2006) Laparoscopic and open retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testis tumors. J Endourol 20(9):627–631

    Article  PubMed  Google Scholar 

  8. Poulakis V, Skriapas K, de Vries R, Dillenburg W, Ferakis N, Witzsch U, Becht E (2006) Quality of life after laparoscopic and open retroperitoneal lymph node dissection in clinical Stage I nonseminomatous germ cell tumor: a comparison study. Urology 68(1):154–160

    Article  PubMed  Google Scholar 

  9. Corvin S, Sturm W, Schlatter E, Anastasiadis A, Kuczyk M, Stenzl A (2005) Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient. J Endourol 19(7):823–826

    Article  PubMed  Google Scholar 

  10. Holman E, Kovács G, Flaskó T, Maróti C, Vancsora J, Tóth C, Salah MA (2007) Hand-assisted laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular cancer. J Laparoendosc Adv Surg Tech A 17(1):16–20

    Article  PubMed  Google Scholar 

  11. LeBlanc E, Caty A, Dargent D, Querleu D, Mazeman E (2001) Extraperitoneal laparoscopic para-aortic lymph node dissection for early stage nonseminomatous germ cell tumors of the testis with introduction of a nerve sparing technique: description and results. J Urol 165(1):89–92

    Article  PubMed  CAS  Google Scholar 

  12. Rassweiler JJ, Frede T, Lenz E, Seemann O, Alken P (2000) Long-term experience with laparoscopic retroperitoneal lymph node dissection in the management of low-stage testis cancer. Eur Urol 37(3):251–260

    Article  PubMed  CAS  Google Scholar 

  13. Nelson JB, Chen RN, Bishoff JT, Oh WK, Kantoff PW, Donehower RC, Kavoussi LR (1999) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular tumors. Urology 54(6):1064–1067

    Article  PubMed  CAS  Google Scholar 

  14. Steiner H, Peschel R, Janetschek G, Höltl L, Berger AP, Bartsch G, Hobisch A (2004) Long-term results of laparoscopic retroperitoneal lymph node dissection: a single-center 10-year experience. Urology 63(3):550–555

    Article  PubMed  Google Scholar 

  15. Bishoff JT, Allaf ME, Kirkels W, Moore RG, Kavoussi LR, Schroder F (1999) Laparoscopic bowel injury: incidence and clinical presentation. J Urol 161(3):887–890

    Article  PubMed  CAS  Google Scholar 

  16. Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, Jarrett TW, Kavoussi LR (2007) Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 177(2):580–585

    Article  PubMed  Google Scholar 

  17. Jewett MAS, Gross RJ (2007) Nerve-sparing retroperitoneal lymphadenectomy. Urol Clin N Am 34(2):149–158

    Article  Google Scholar 

  18. Eichel L, McDougall EM, Clayman RV (2007) Basics of laparoscopic surgery. In: Wein AJ, Kavoussi LR, Peters CA, Novick AC, Partin AW (eds) Campbell-Walsh urology. Saunders Elsevier, Philadelphia, pp 171–220

    Google Scholar 

  19. Leibovitch I, Mor Y, Golomb J, Ramon J (2002) The diagnosis and management of postoperative chylous ascites. J Urol 167((2 Pt 1)):449–457

    PubMed  Google Scholar 

  20. Leibovitch I, Mor Y, Golomb J, Ramon J (2002) Chylous ascites after radical nephrectomy and inferior vena cava thrombectomy Successful conservative management with somatostatin analogue. Eur Urol 41(2):220–222

    Article  PubMed  Google Scholar 

  21. Castillo OA, Litvak JP, Kerkebe M, Olivares R, Urena R (2006) Case report: laparoscopic management of massive chylous ascites after salvage laparoscopic retroperitoneal lymph-node dissection. J Endourol 20(6):394–396

    Article  PubMed  Google Scholar 

  22. Winfree CH, Kline DG (2005) Intraoperative positioning nerve injuries. Surg Neurol 63(1):5–18

    Article  PubMed  Google Scholar 

  23. Beck SD, Peterson MD, Bihrle R, Donohue JP, Foster RS (2007) Short-term morbidity of primary retroperitoneal lymph node dissection in a contemporary group of patients. J Urol 178(2):504–506

    Article  PubMed  Google Scholar 

  24. Permpongkosol S, Lima GC, Warlick CA, Allaf ME, Varkarakis IM, Bagga HS, Kohanim S, Kavoussi LR (2007) Postchemotherapy laparoscopic retroperitoneal lymph node dissection: evaluation of complications. Urology 69(2):361–365

    Article  PubMed  Google Scholar 

  25. Rassweiler JJ, Seemann O, Henkel TO, Stock C, Frede T, Alken P (1996) Laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors: indications and limitations. J Urol 156(3):1108–1113

    Article  PubMed  CAS  Google Scholar 

  26. Hara I, Kawabata G, Yamada Y, Tanaka K, Kamidono S (2004) Extraperitoneal laparoscopic retroperitoneal lymph node dissection in supine position after chemotherapy for advanced testicular carcinoma. Int J Urol 11(10):934–939

    Article  PubMed  Google Scholar 

  27. Palese MA, Su LM, Kavoussi LR (2002) Laparoscopic retroperitoneal lymph node dissection after chemotherapy. Urology 6(1):130–134

    Article  Google Scholar 

  28. Mosharafa AA, Foster RS, Koch MO, Bihrle R, Donohue JP (2004) Complications of post-chemotherapy retroperitoneal lymph node dissection for testis cancer. J Urol 171(5):1839–1841

    Article  PubMed  Google Scholar 

  29. Nash PA, Leibovitch I, Foster RS, Bihrle R, Rowland RG, Donohue JP (1998) En bloc nephrectomy in patients undergoing post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous testis cancer: indications, implications and outcomes. J Urol 159(3):707–710

    Article  PubMed  CAS  Google Scholar 

  30. Stephenson AJ, Tal R, Sheinfeld J (2006) Adjunctive nephrectomy at post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer. J Urol 176(5):1996–1999

    Article  PubMed  Google Scholar 

  31. Nielsen ME, Lima G, Schaeffer EM, Porter J, Cadeddu JA, Tuerk I, Kavoussi LR (2007) Oncologic efficacy of laparoscopic RPLND in treatment of clinical stage I nonseminomatous germ cell testicular cancer. Urology 70(6):1168–1172

    Article  PubMed  Google Scholar 

  32. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Urology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    Patrick A. Kenney & Ingolf A. Tuerk

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  1. Patrick A. Kenney
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  2. Ingolf A. Tuerk
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Correspondence to Ingolf A. Tuerk.

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Kenney, P.A., Tuerk, I.A. Complications of laparoscopic retroperitoneal lymph node dissection in testicular cancer. World J Urol 26, 561–569 (2008). https://doi.org/10.1007/s00345-008-0299-3

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  • DOI: https://doi.org/10.1007/s00345-008-0299-3

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