Retroperitoneal laparoscopic excision of the recurrence mass at the patient that is treated open RPLND due to testicular tumor

Abstract

In recently many laparoscopic surgical procedures in urology have been performed successfully with the help of technological advances. It is an invasive procedure that is retroperitoneal lymph node dissection (RPLND) laparoscopic retroperitoneal approach can be applied. Twenty-four year-old male patient, 7 years ago has been performed radical orchiectomy at epicentral clinic. The pathology of testicular mass was embryonal carcinoma. Two cycles of BEP (bleomycin, etoposide and cisplatin) chemotherapy procedure has been treated. Mass was found in the retroperitoneum 5 years later. Open transperitoneal retroperitoneal lymph node dissection surgery was performed at epicentral clinic. AFP has come to normal values after the operation. AFP was detected 50 IU/ mL 2 years later. Patients with recurrent retroperitoneal mass was referred to our clinic. In our clinic the patient was underwent laparoscopic retroperitoneal excision for the recurrent mass. Operation time were 90 minutes. Mass was localizated psoas muscle infero-lateral and sized 24 mm. Patient was hospitalized for 2 days. The drainage catheter was taken out postoperative second day. There was no complication. 

Keywords

• Laparoscopy
• retroperition
• mass
• recurrence

Testis tümörü nedeniyle açık RPLND uygulanmış hastada nüks eden kitlenin Laparoskopik retroperitoneal eksizyonu

Abstract

Son zamanlarda teknolojinin tıbba yaptığı katkılarla ürolojide birçok ameliyat laparoskopik olarak yapılmaya başlanmıştır. Retroperitoneal lenf nodu diseksiyonu da (RPLND) laparoskopik yaklaşımla uygulanabilmektedir. Yirmidört yaşında erkek hastaya 7 yıl önce testis kitlesi nedeniyle orşiektomi yapılmış. Patoloji embriyonel karsinom gelmiş. Hasta 2 kür BEP (Bleomisin, Etoposide ve Sisplatin) tedavisi almış. Beş yıl sonra tümör belirteçlerinde yükselme ve retroperitonda kitle saptanmış. Açık transperitoneal yaklaşımla bilateral retroperitoneal lenf nodu diseksiyonu operasyonu yapılmış. Sonrasında AFP normal değerlere gelmiş. Takiplerinde 2 yıl sonra AFP 50 IU/mL saptanmış. Retroperitoneal nüks kitle saptanan hasta kliniğimize refere edilmiş. Hastaya laparoskopik retroperitoneal kitle eksizyonu yapıldı. Operasyon süresi 90 dakikaydı. Sol psoas kası infero-lateralinde 24 mm kitle eksize edildi. Hasta postoperatif ikinci günde direni consulted bir komplikasyon gelişmeden taburcu edildi. 

Keywords

• Laparoskopi
• retroperiton
• kitle
• nüks

References

1. 1. Joseph A.Smith Jr,Stuard S. Howard Genel Üroloji, Onaltıncı Baskı Türkçe Edisyon 2004;386-394.
2. 2. Alan J. Wein,Kavoussi Partin,Novick Peter, Campbell’s Urology, Eighth Edition 2002;2411-244.
3. 3. Ellis JH, Bies JR, Kopecky KK at al. Comparison of NMR and CT imaging in the evaluation of metastatic retroperitoneal lymphadenopathy from testicular carcinoma JP. J 1984;8:709-19.
4. 4. Roberts JB. Excision of lumbar lymphatic nodes and spermatic vein in malignant diseases of the testide.Ann Surg 1902; 36:539-41.
5. 5. Cullen MH, Stenning SP, Parkinson MC at al. Short-course adjuvant chemotherapy in high-risk stage I nonseminoma germ cell tumours of the testis: a Medical Research Council report. J Clin Oncol 1996;14: 1106- 1113.
6. 6. Vidal AD, Thalmann GN, Karamitopoulou-Diamantis E at al. Long-term outcome of patients with clinical stage I high-risk nonseminomatous germ-cell tumors 15 years after one adjuvant cycle of bleomycin, etoposide, and cisplatin chemotherapy. UE. Ann Oncol 2015;26:374-7.
7. 7. Oliver RTD, Raj MA, Ong J at al, Pilot study to evaluate impact of a policy of adjuvant chemotherapy for risk stage I malignant teratoma on overall relapse rate of stage I cancer patients. J Urol 1992; 148: 1453-1456.
8. 8. Bland-SuttonJ. at al, An mproved method of removing the testide and spermatic cord for malignant disease. Lancet 1909; 2:1406.

9. 9. Rukstalis DB, Chodak GW: Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol 1992;148: 1907-9.
10. 10. Janetschek G, Hobisch A, Holtl L at al: Retroperitoneal lymphadenectomy for clinical stage I nonseminomatous testicular tumor: Laparoscopy versus open surgery and impact of learning curve. J Urol 1996;156: 89-93.
11. 11. McKiernan JM,Motzer RJ, Bajorin DF et al. Reoperative retroperitoneal surgery for nonseminomatous germ cell tumor: clinical presentation, patterns of recurrence, and outcome. J Urology 2003; 62: 732-6.
12. 12. Sheinfeld J, Sogani P. Re-operative retroperitoneal surgery in testicular cancer. Urol Clinics North Am 2007; 34: 227–33.
13. 13. Eastham JA, Wilson TG, Russell C et al. Surgical resection in patients with nonseminomatous germ cell tumor who fail to normalize serum tumor markers after chemotherapy. Urology 1994; 43: 74–80.