Abstract
Background
Laparoscopic retroperitoneal lymph node dissection of paraaortic and paracaval lymph nodes is used to stage nonseminomatous germ cell tumors. Primary tumors can arise from the retroperitoneum, and tumors from nonurologic malignancy also may metastasize to retroperitoneal lymph nodes. This study aimed to describe the authors’ experience with laparoscopic resection of these lesions.
Methods
A consecutive series of patients between January 2007 and June 2011 with paraaortic, aortocaval, or paracaval tumors with a maximum diameter smaller than 10 cm and confined to the abdomen were considered for laparoscopic resection. Data were collected on size and pathology of the lesions, anesthesia time, postoperative stay, and postoperative morbidity and mortality.
Results
In this study, 25 patients with a median age of 49 years were assessed for laparoscopic resection. Eight patients were considered unsuitable for a laparoscopic approach because of tumor location (n = 5), previous retroperitoneal surgery (n = 1), stoma (n = 1), or lesion not clearly visible on computed tomography (n = 1). Of the 17 patients undergoing laparoscopic resection, 1 was found to have diffuse peritoneal disease at laparoscopy, whereas another was converted to an open procedure due to bleeding. All the laparoscopic patients had an R0 resection. The median hospital stay was significantly shorter in the laparoscopic group (2 days) than in the open group (6 days) (P = 0.009). One patient in the laparoscopic group with a functioning paraganglioma and advanced cardiac disease died on postoperative day 7.
Conclusion
Laparoscopic paraaortic and paracaval surgery for primary and recurrent tumors of the retroperitoneum is feasible, with clear resection margin rates similar to that observed for open surgery.
Similar content being viewed by others
References
Rukstalis DB, Chodak GW (1992) Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol 148:1907–1909 discussion 1909–1910
Rassweiler JJ, Scheitlin W, Heidenreich A, Laguna MP, Janetschek G (2008) Laparoscopic retroperitoneal lymph node dissection: does it still have a role in the management of clinical stage I nonseminomatous testis cancer? A European perspective. Eur Urol 54:1004–1015
MacKay G, Ihedioha U, McConnachie A, Serpell M, Molloy RG, O’Dwyer PJ (2007) Laparoscopic colonic resection in fast-track patients does not enhance short-term recovery after elective surgery. Colorectal Dis 9:368–372
Parnaby CN, Chong PS, Chisholm L, Farrow J, Connell JM, O’Dwyer PJ (2008) The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc 22:617–621
Ahn KSMD, Han H-SMDP, Yoon Y-SMDP, Kim H-HMDP, Lee T-SMDP, Kang S-BMDP et al (2011) Laparoscopic resection of nonadrenal retroperitoneal tumors. Arch Surg 146:162–167
Walz MK, Alesina PF, Wenger FA, Koch JA, Neumann HP, Petersenn S et al (2006) Laparoscopic and retroperitoneoscopic treatment of pheochromocytomas and retroperitoneal paragangliomas: results of 161 tumors in 126 patients. World J Surg 30:899–908
Kasza J, Brody FJ, Khambaty F, Vaziri K, Wallace B (2010) Laparoscopic resection of a retroperitoneal cystic lymphangioma in an adult. Surg Laparosc Endosc Percutan Tech 20:e114–e116
Gorgun M, Sezer TO, Kirdok O (2010) Laparoscopic resection of retroperitoneal schwannoma near the inferior vena. Ann Vasc Surg 24(551):e551–e554
Sasaki A, Suto T, Nitta H, Shimooki O, Obuchi T, Wakabayashi G (2010) Laparoscopic excision of retroperitoneal tumors: report of three cases. Surg Today 40:176–180
Misra MC, Bhattacharjee HK, Hemal AK, Bansal VK (2010) Laparoscopic management of rare retroperitoneal tumors. Surg Laparosc Endosc Percutan Tech 20:e117–e122
Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211
Disclosures
Lucia Chung and Patrick J. O’Dwyer have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chung, L., O’Dwyer, P.J. Laparoscopic resection of paraaortic or paracaval lesions: feasibility and outcome. Surg Endosc 27, 4153–4156 (2013). https://doi.org/10.1007/s00464-013-3013-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3013-5