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Fàbregas Drnda, M; Puig Ortuño, L; Buisan Rueda, O; Lozano Santana, V; Pérez Reggeti, JI; Serrallach Orejas, M; Suárez Novo, JF; Vigués Julià, F
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Introduction & Objectives
Minimally invasive retroperitoneal lymph node dissection (MI-RPLND) is an emerging surgical option for residual masses after chemotherapy in germ cell tumor, with less morbidity than open approach (O-RPLND). The aim of this study is to compare the perioperative outcomes of MI-RPLND with O-RPLND and assess its oncological safety and feasibility which is lacking in current evidence. We report our experience in Hospital Universitari de Bellvitge, centre with CSUR acreditation for the treatment of intermediate and high risk germ cell tumors resistant to first line chemotherapy in adults since 2017.
Materials & Methods
A retrospective cohort study was conducted. All patients undergoing RPLND in our center from 2006 to 2022 were included (n=108). Those who underwent MI-RPLND were compared to those treated with O-RPLND.
Results
eport 76 cases of MI-RPLND and 32 cases of O-RPLND. Conversion rate to open approach was 3.7%. No differences were found regarding mean age, previous histopathological diagnosis, clinical stage and IGCCCG prognostic group. Mean size was 62,3mm and 89,3mm respectively (p=0,007). Bilateral template and radiological infiltration of other organs were also important factors to indicate O-RPLND (p=0,001). The most frequent histopathological finding was teratoma (58,5%), followed by necrosis (27,8%) and the presence of viable germ cell tumor (13,9%). Operating time, days of hospitalization and complication rate were lower in MI-RPLND (p=0,001 and p=0,002). With a mean follow-up of 73,9 months, no differences were found regarding incomplete resection rate, recurrence and site of recurrence (p >0,05).
Conclusion
Compared to O-RPLND, MI-RPLND offers better results in terms of hospitalization length and complication rates with no difference when it comes to oncological outcomes in well-selected patients.
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