Alternative approaches to retroperitoneal lymph node dissection for paratesticular rhabdomyosarcoma
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In brief
In brief
Retrospective study of 20 paratesticular rhabdomyosarcoma patients demonstrates retroperitoneoscopic RPLND achieves shorter hospital stays, reduced opioid use, and faster chemotherapy initiation compared to open and laparoscopic approaches, with equivalent lymph node yields. ICG lymphatic mapping successfully identified iliac node drainage patterns.
Written by the GCMD Library team from the article.
Abstract
Purpose
The aim of this study was to evaluate outcomes based on surgical approach for retroperitoneal lymph node dissection (RPLND) in patients with paratesticular rhabdomyosarcoma (PT-RMS).
Methods
Patients undergoing RPLND for PT-RMS over 10 years at a single institution were retrospectively reviewed. Length of stay (LOS), complications, oral morphine equivalents per kilogram (OME/Kg), lymph node yield, and time to chemotherapy were assessed. The surgical approaches compared were: open transabdominal, open extraperitoneal, laparoscopic, and retroperitoneoscopic. For cases with lymphatic mapping, indocyanine green (ICG) was injected into the spermatic cord.
Results
Twenty patients were included: five open transabdominal, six open extraperitoneal, three laparoscopic, and six retroperitoneoscopic operations. LOS was shorter in the retroperitoneoscopic group than laparoscopic (p = 0.029) and both open groups (p < 0.001). Mean OME/kg used was lowest in the retroperitoneoscopic (0.13 ± 0.15) group compared to laparoscopic (0.68 ± 0.53, p = 0.043), open transabdominal (14.90 ± 8.87, p = 0.003), and extraperitoneal (10.11 ± 2.44, p < 0.001). Time to chemotherapy was shorter for retroperitoneoscopic patients (0.13 days ± 0.15) compared to open transabdominal (15.6 days±6.5, p = 0.005). There was no difference in lymph node yield between groups. Spermatic cord ICG demonstrated iliac lymph node avidity on near-infrared spectroscopy.
Conclusions
Minimally invasive RPLND appears to offer a faster recovery without compromising lymph node yield for patients with PT-RMS.
Level of Evidence
III.