Dados do Trabalho

Título

LAPAROSCOPIC RETROPERITONEAL LYMPH NODE DISSECTION AFTER CHEMOTHERAPY - STEP BY STEP APPROACH IN A REFERENCE AND TEACHING CENTER IN URO-ONCOLOGY

Introdução e Objetivo

Patients with non-seminomatous germ cell tumor (NSGCT) even after chemotherapy may develop residual retroperitoneal disease, so retroperitoneal lymph node dissection (RPLND) is indicated. Although the gold standard approach is still open surgery, laparoscopic surgery is feasible and brings great benefits to these patients. In the academic setting today, there are no teaching modules widely available to train urology students and residents for the procedure. In this sense, we aim to present the surgical technique for laparoscopic RPLND, step by step and standardized for teaching.

Método

A 34-year-old male with left testicular enlargement for 3 months. Physical examination revealed an enlarged and hardened left testicle. Clinical examinations alpha-fetoprotein (27ng/mL) and beta-HCG (116ng/dL). The patient underwent a left radical orchiectomy. The histology confirmed an NSGCT (endodermal sinus tumor (70%) and embryonal carcinoma (30%), compromising spermatic cord and lymphovascular invasion). Computed tomography paraaortic lymph nodes measuring 8.2x4.2x4.1cm and pulmonary nodules measuring about 1.5 cm (pT3cN3M0S1 - stage IIC according to classification of the International Union Against Cancer, 2016, 8th edn.). The patient underwent 4 cycles of etoposide and cisplatin. After 2 moths, the tumor markers became negative, but the patient still presented residual paraortic retroperitoneal mass of 3.7 x 3.0 cm. Therefore, laparoscopic RPLND was performed in a reference center for the treatment of testicular cancer.

Resultados

RPLND was performed uneventfully. The operative time was 210 minutes, blood loss was 100 ml, and there were no intra-operative or postoperative complications. The patient was discharged from the hospital on the 1st postoperative day. The histology confirmed teratoma, in a mass of 5.6 x 3.5cm, additionally 35 lymph nodes were resected without viable cancer. After 1 year of follow-up, the patient is asymptomatic, with anterograde ejaculation, and negative tumor markers.

Conclusão

Laparoscopic RPLND is a feasible procedure with acceptable morbidity even for post-chemotherapy patients, which should be encouraged in the training of urology residents.