Clinical experience and outcomes of post chemotherapy midline extraperitoneal approach to retroperitoneal lymph node dissection

TL;DR

This study examines the outcomes of a specific surgical approach for treating testicular cancer after chemotherapy, showing acceptable results and preserved function.

Contribution

The paper introduces the midline extraperitoneal approach for post-chemotherapy retroperitoneal lymph node dissection in testicular cancer.

Findings

The midline EP approach had acceptable perioperative outcomes with a median lymph node yield of 18.

91% of patients preserved ejaculatory function after the procedure.

There were four early complications but no late complications reported.

Abstract

To detail the outcomes of an open midline extraperitoneal (midline EP) approach to post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic testicular cancer.

We analysed our prospectively maintained operative database from April 2020 to February 2023 for cases of midline EP approach to PC-RPLND, identifying a total of 11 patients across two hospitals in Sydney, Australia. Demographic and perioperative data was obtained from electronic medical records, including preoperative factors such as cancer staging and preoperative treatment.

Eleven patients were included in this study. The median age was 37 years with a median ASA grade of 3. There were a total of six left-sided and five right-sided cases. A modified template was used in eight cases, and a bilateral template was used in three. Tumour staging ranged from Stage IIA– IIIB, with a median maximal retroperitoneal tumour size post chemotherapy of 4.2 cm. Preoperative histology identified 4 cases of seminoma and 7 cases of nonseminomatous germ cell tumours (NSGCT). The median length of the procedure was 300 min, blood loss was 300mL, length of stay was 5 days, and post-operative days until bowel opening was 2 days. The median lymph node yield was 18, with active malignancy identified in five cases. There were four early complications and no late complications. 91% of the patients had preserved ejaculatory function.

The open midline EP approach to PC-RPLND has demonstrated acceptable perioperative outcomes compared to other open surgical approaches, enabling surgeons to complete complex cases. Therefore, the midline EP approach should be considered when performing PC-RPLND.

The online version contains supplementary material available at 10.1186/s12894-025-01853-0.

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