Presentation Authors: Madeleine L. Burg*, Laya Jacob, Saum Ghodoussipour, Shane M. Pearce, Sumeet Bhanvadia, Hooman Djaladat, Anne K. Schuckman, Siamak Daneshmand, Los Angeles, CA
Introduction: Midline extraperitoneal retroperitoneal lymph node dissection (EP-RPLND) for testicular germ cell tumors (GCT) has been shown to have significantly decreased morbidity compared to a transperitoneal approach. We aimed to review patients who underwent EP-RPLND for surgical outcomes.
Methods: Using an IRB approved TGCT database, all patients who underwent either primary or post-chemotherapy EP-RPLND from 2010-2017 were reviewed. Surgical variables recorded include estimated blood loss (EBL) and intraoperative blood transfusions, if nerve-sparing and other intraabdominal procedures performed, largest preoperative lymph node/mass size (per imaging), lymph node yield, length of hospital stay (LOS), postoperative ejaculatory function, and 90-day complications per Clavien-Dindo classification system (CD).
Results: Out of 131 EP-RPLND performed, 105 were consented for TGCT database. 3 patients who underwent desperation EP-RPLND were excluded, resulting in 102 patients. 30 patients underwent primary EP-RPLND (6 CS I, 19 CS IIA, 4 CS IIB, 1 CS IIC). 72 patients underwent EP-PC-RPLND. Surgical outcomes listed in Table 1. Median LOS was 3 days (IQR 2-3). 83 patients (81%) underwent nerve-sparing procedure. 66 patients (65%) had documented ejaculatory function of which 57 patients underwent nerve-sparing procedure. Of those 57 patients, 54 patients (95%) maintained antegrade ejaculation, with 1 CS IIA primary EP-RPLND patient resulting in retrograde ejaculation and 2 EP-PC-RPLND patients (preoperative mass sizes of 2.1 and 6.0 cm). 88 patients (86%) had at least 90-day follow-up with 7 patients (8%) having a complication (6 patients CD I-II, 1 patient CD III). Median length of follow-up time was 590 days (IQR 336-1,221).
Conclusions: Midline EP-RPLND is a safe and effective procedure. Majority of patients have preserved ejaculatory function, and LOS and complication rates are comparable to minimally invasive procedures.