Is there a limit for the laparoscopic approach of a retroperitoneal residual masspostchemotherapy?

© 2014 AEU. Published by Elsevier España, S.L.U. All rights reserved. Objectives: Rescue lymphadenectomy for testicular cancer is a complex surgery, with a highnumber of complications. The laparoscopic approach appears to offer faster recovery andimproved quality of life compared with open surgery. The aim of our study is to report onour experience and to define whether there is a limit (oncological, anatomical or technical) forlaparoscopic management.Material and methods: A retrospective study was conducted of 15 patients who underwentlaparoscopic retroperitoneal lymphadenectomy after chemotherapy. In addition to epidemio-logical and oncologic variables, we analyzed the mean surgical time, intraoperative andpostoperative complications, the mean hospital stay and the mean follow-up time.Results: The mean surgical time was 294 minutes (range, 180-240). There were 4 large-vesselvascular lesions, all of which were large-volume retroperitoneal masses, with diameters > 7 cm.The rate of postoperative complications was 33%; there was only 1 case of Clavien >III. Themean hospital stay was 5.38 days (range, 2-9), and the mean patient follow-up was 28.9 months(range, 1-79). There was no recurrence in any of the cases.Conclusions: The laparoscopic approach is an oncologically safe option for the rescue treatmentof testicular cancer. The complex location of these masses entails the onset of severe intrao-perative complications. We have observed a clear relationship between vascular complicationsand large masses (> 7 cm). We therefore believe that it would be appropriate to establish a limiton the size for laparoscopic treatment.