Linfadenectomía retroperitoneal laparoscópica primaria para el tumor testicular de células germinales no seminomatoso en estadio clínico I

introduction: this report is intended to retrospectively assess cancer control and morbidity of primary laparoscopic reproperitoneal lymphadenectomy (l-rplnd) in patients with clinical stage i non seminomatous germ cell tumour (nsgct). materials and methods: one hundred and sixty-four patients with clinical stage i nsgct underwent primary diagnostic lrplnd between 1993 and 2006. patients were operated unilaterally limiting the dissection to templates. kaplan meier curves were generated estimating time to recurrence. results: of the 164 patients, 82 (48%) had embryonal components and 35 (20%) lymphovascular invasion in the orchiectomy specimen. the median (iqr) age, operative time, length of hospital stay, blood loss and number of lymph nodes retrieved was 28 years (24-33), 135 minutes. (120- 180), 48 hours (24-48), 50 cc (20-100) and 14 (10-18) nodes, respectively. all patients had negative serum markers preoperatively. presence of lymph node metastasis was identified in 32 (19.5%) patients. follow-up was available in 15 of these. fourteen received adjuvant chemotherapy and 2 of them had recurrence at 3 and 64 months. absence of lymph node metastasis was diagnosed in 132 (80.5%) patients. follow-up was available in 80 of these. among them 7 recurred (5 retroperitoneum, 2 lung), one of them 33 months after l-rplnd. median follow-up for patients without recurrence was 14 months (iqr:4-35). the cumulative 3-year recurrence free rate was 82% (95%ci: 64-91). seventeen (10%) of 164 patients had intra or perioperative complications. conclusions: this is the largest series of l-rplnd performed in a single institution. both morbidity and oncologic safety of this technique needs to be prospectively evaluated in randomized trials.