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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Aufderklamm, S; Todenhöfer, T; Hennenlotter, J; Mischinger, J; Böttge, J; Rausch, S; Halalsheh, O; Stenzl, A; Gakis, G; Schwentner, C.
Postchemotherapy laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors infiltrating the great vessels.
J Endourol. 2014; 28(6):668-674 Doi: 10.1089/end.2013.0755
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Co-Autor*innen der Med Uni Graz
Mischinger Johannes

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Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is an alternative in patients with metastatic nonseminomatous germcell tumors (NSGCT) necessitating resection of residuals postchemotherapy. With the advancement of laparoscopic vascular surgery, prospective management of the great vessels has become feasible and safe. We present our experience with L-RPLND in NSGCT residuals with significant vascular involvement necessitating intracorporeal reconstruction. We have retrospectively identified 19 NSGCT patients (mean age 27 years) who presented with residuals postchemotherapy. A bilateral L-RPLND was performed in all men. Infiltration of the great vessels was confirmed intraoperatively. Prospective vascular control and temporary clamping was performed in all cases. The vessel wall was reconstructed using vascular surgery techniques. All patients had at least clinical stages of IIA or higher. Follow-up was obtained in all. There were no conversions to open surgery. The mean size of the residuals after chemotherapy was 3.87 cm (1.5-9.7 cm). The mean blood loss was 310 mL (50-1000 mL). Mean hospital stay was 6 days (3-9 days). There were no perioperative complications exceeding grade II according to the Clavien-Dindo classification. Distant or in-field recurrence (mean observational period 18 months) did not develop in any patient. Laparoscopic RPLND may be considered a safe alternative concept for the management of post-chemotherapy NSGCT residuals involving the great vessels. Bilateral L-RPLND in patients with vascular infiltration is feasible and reproducible when laparoscopic vascular surgery can be reliably handled. All standard principles of open surgery are respected, and initial oncologic results are promising.
Find related publications in this database (using NLM MeSH Indexing)
Adult -
Aorta - pathology
Aorta - surgery
Humans -
Laparoscopy - methods
Length of Stay -
Lymph Node Excision - methods
Male -
Neoplasm Invasiveness - pathology
Neoplasm Recurrence, Local - surgery
Neoplasm Staging -
Neoplasm, Residual - pathology
Neoplasms, Germ Cell and Embryonal - drug therapy
Neoplasms, Germ Cell and Embryonal - secondary
Neoplasms, Germ Cell and Embryonal - surgery
Retroperitoneal Neoplasms - drug therapy
Retroperitoneal Neoplasms - secondary
Retroperitoneal Neoplasms - surgery
Retroperitoneal Space - surgery
Retrospective Studies -
Testicular Neoplasms - surgery
Venae Cavae - pathology
Venae Cavae - surgery

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