Primary laparoscopic RPLND for pure seminona metastasis: feasibility of supine and lateral approaches

ABSTRACT

Introduction

Retroperitoneal lymphadenectomy (RPLND) is well established as a primary treatment, especially for high-risk stage I and stage IIA/B nonseminomatous tumors, but its value in seminomatous tumors is underreported (¹). Classically, seminomas with isolated retroperitoneal lymphadenopathy are treated with external beam radiation therapy or systemic chemotherapy. Although these modalities are effective, they are associated with significant long-term morbidity (², ³). Some retrospective studies have demonstrated the potential of RPLND as a first-line treatment for stage IIa seminoma, and two very recent prospective trials, still with interim results: SEMS TRIAL and PRIMETEST(^3-7). The RPLND robotic technique has been previously described in the post-chemotherapy scenario, however, surgical videos of primary laparoscopic approach are lacking, especially in seminomatous disease (⁸).

Materials and Methods

We present two cases of primary videolaparoscopic RPLND, using different approaches.Case 1: Thirty four years-old, with prior right orchiectomy for mixed tumor. After 8 months he presented an two cm enlarged interaortocaval lymph node. Percutaneous biopsy showed pure seminoma metastasis.Case 2: Thirty three years-old, with previous left orchiectomy for stage I pure seminoma, without risk factors. After nine months, the patient had a three cm enlarged para-aortic lymph node.

Results

The surgical time ranged from 150 to 210 minutes, with a maximum bleeding of 300 mL and hospital discharge in 48 hours. In one of the cases, we identified a significant desmoplastic reaction, with firm adhesions to the great vessels, requiring vascular sutures, however, no major complication occurred. Pathological anatomy confirmed pure seminoma lymph node metastases in both cases.

Conclusion

Laparoscopic primary RPLND proved to be technically feasible, with less postoperative pain and early hospital discharge. We understand that more studies should be performed to confirm our oncological results.

REFERENCES

• ¹
  Ray S, Pierorazio PM, Allaf ME. Primary and post-chemotherapy robotic retroperitoneal lymph node dissection for testicular cancer: a review. Transl Androl Urol. 2020;9:949-58.
• ²
  Aydin AM, Zemp L, Cheriyan SK, Sexton WJ, Johnstone PAS. Contemporary management of early stage testicular seminoma. Transl Androl Urol. 2020;9(Suppl 1):S36-S44.
• ³
  Hu B, Shah S, Shojaei S, Daneshmand S. Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma. Clin Genitourin Cancer. 2015;13:e265-e269.
• ⁴
  Tabakin AL, Shinder BM, Kim S, Rivera-Nunez Z, Polotti CF, Modi PK, et al. Retroperitoneal Lymph Node Dissection as Primary Treatment for Men With Testicular Seminoma: Utilization and Survival Analysis Using the National Cancer Data Base, 2004-2014. Clin Genitourin Cancer. 2020;18:e194-e201.
• ⁵
  Hu B, Daneshmand S. Retroperitoneal Lymph Node Dissection as Primary Treatment for Metastatic Seminoma. Adv Urol. 2018;2018:7978958.
• ⁶
  Daneshmand S, Cary C, Masterson TA, Einhorn L, Boorjian SA, Kollmannsberger CK, et al. SEMS trial: Result of a prospective, multi-institutional phase II clinical trial of surgery in early metastatic seminoma. J Clin Oncol [Internet]. 2021;39(6_suppl):375. Available at. <https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.6_suppl.375>
  » https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.6_suppl.375
• ⁷
  Albers P, Lusch A, Che Y, Arsov C, Niegisch G, Hiester A. The PRIMETEST trial: Prospective phase II trial of primary retroperitoneal lymph node dissection (RPLND) in stage II A/B patients with seminoma. J Clin Oncol [Internet]. 2022;40(6_suppl):420. Available at. <https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.6_suppl.420>
  » https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.6_suppl.420
• ⁸
  Gomes DC, Da Costa WH, Brazão ÉS Jr, Vergamini LB, Ricci BV, Zequi SC. Robot-assisted retroperitoneal lymphadenectomy (RPLND): video case report. Int Braz J Urol. 2021;47:907.

• Available at: http://www.intbrazjurol.com.br/video-section/20220370_Zequi_et_al

Publication Dates

• Publication in this collection
  09 June 2023
• Date of issue
  Mar-Apr 2023

History

• Received
  18 July 2022
• Accepted
  28 July 2022
• Published
  20 Aug 2022