Login to Access Video or Poster Abstract: MP80-10
Sources of Funding: none

Introduction

Retroperitoneal lymph node dissection (RPLND) is an important component of the management of testicular germ cell tumor (GCT) but carries significant morbidity. Herein we describe our updated experience with a midline extraperitoneal (EP) approach to RPLND for seminomatous and non-seminomatous GCT that minimizes perioperative morbidity.

Methods

122 consecutive patients from an IRB approved database underwent RPLND from 2010-2015. Patients requiring aortic resection, retrocrural dissection or access to intraperitoneal disease were excluded. The remaining 69 patients underwent midline EP-RPLND. All post-chemotherapy (PC) cases underwent bilateral template dissection; all primary cases underwent extended ipsilateral templates. Perioperative and long-term outcomes were analyzed and a descriptive analysis using SAS was performed.

Results

68 patients underwent midline EP-RPLND successfully (98.6%). Median age was 28 years. On pre-operative imaging the size of retroperitoneal mass or lymphadenopathy was <2 cm in 29 patients, 2-5 cm in 15 patients, and >5 cm in 24 patients, of which 19 were >10cm. 3 patients underwent cavectomy. Median EBL was 325 mL (IQR: 200-612.5). Median number of lymph nodes (LN) resected was 36 (IQR: 24.5-49); median number of positive nodes was 1 (IQR: 0-4). Median return of bowel function was 2 days (IQR: 1-2) and LOS was 3 days (IQR: 3-4). There were no cases of ileus. 11 patients (16.2%) had 30-day complications: 6 (55%) were Clavien grade 1, 5 (45%) were grade 2. There was 1 long-term complication (1.5%), which was grade 3b. Antegrade ejaculation rates were 91.6% in the primary group and 96.8% in the PC group. _x000D_ _x000D_

Conclusions

Midline EP-RPLND can be performed safely without compromising completeness of resection. This approach is associated with a faster return of bowel function, lower rates of ileus and shorter LOS.

Funding

none