Objectives: Laparoscopic lumbo-aortic lymphadenectomy is proposed in order to decrease the morbidity of pretreatment lymph node dissections for early stage NSGCT of the testis. Two approaches are presented and compared retrospectively: the transperitoneal approach and the extraperitoneal approach.
Material and methods: From 1991 to 1999, 57 patients with clinical stage I (50) to IIA (7) NSGCT underwent pretreatment laparoscopic investigation of the para-aortic lymph nodes: 32 transumbilical transperitoneal dissections and 25 internal iliac extraperitoneal dissections were performed.
Results: Only the 19 patients with lymph node invasion received chemotherapy. All serious complications occurred in the transperitoneal group: 1 case of chylous ascites and 2 cases of transient neurological complications, 2 cases of permanent ejaculation failure and 2 extranodal recurrences among the 38 pN0 patients.
Conclusions: Laparoscopy, especially extraperitoneal, appears to be a safe, effective and appropriate modality for pretreatment lumbo-aortic lymph node evaluation in early stage NSGCT of the testis.