Laparoscopic retroperitoneal lymph node dissection in testicular cancer: feasibility and safety at a tertiary center

Objective: To bear the evidence that laparoscopy is the possible new treatment of choice in the management of retroperitoneal disease in patients with testicular cancer.The surgical management of retroperitoneal lymph nodes is a crucial step in the multidisciplinary treatment of testicular germ cell tumors.Laparoscopic retroperitoneal approach poses technical challenges in urologic oncology.This study reports on the safety, efficacy, and short-term oncological outcomes of laparoscopic retroperitoneal lymph node dissection at a tertiary referral hospital.Method: Prospective, observational, descriptive study conducted from 2021 to 2023, including 83 patients who underwent laparoscopic retroperitoneal lymph node dissection.Results: Eleven cases of primary laparoscopic retroperitoneal lymph node dissection (13.3%), 36 standard (43.3%),22 salvage (26.5%), 11 desperation (13.3%), and 3 redo cases (3.6%) were performed.In primary cases, 81.9% of patients had positive nodes (pN1-3).The conversion rate to open surgery was 6%.Bleeding, lymph node volume, pre-lymphadenectomy markers, chemotherapy, initial histology, and lymph node histology were not risk factors for conversion = Mean surgical time was 250 minutes.There were no major complications (organ injury, vascular injury) or need for blood transfusion = Mean blood loss was 60 mL.Recurrence rate was 9.6%, with recurrence-free survival of 36.7 months.Conclusions: The reported experience demonstrated the safety and efficacy of primary laparoscopic retroperitoneal lymph node dissection, as well as post-chemotherapy cases.Laparoscopic approach allows for early patient recovery without compromising oncological outcomes.It is advisable to perform this surgery in high-volume centers with experienced surgeons in retroperitoneal surgery.