PURPOSE A midline extraperitoneal approach for retroperitoneal lymph node dissection (EP-RPLND) has been associated with decreased morbidity compared to the transperitoneal approach. We aimed to review our 11-year experience in patients with germ cell tumors (GCTs) who underwent EP-RPLND at a single institution. MATERIALS AND METHODS All patients with GCT who underwent EP-RPLND between 2010 and 2021 were reviewed. Surgical, perioperative, and oncologic outcomes were reported. A logistic regression model was developed to evaluate variables predictive of early discharge. Oncologic outcomes included 2-year recurrence-free survival (RFS) and recurrence patterns, which were analyzed according to pathology. RESULTS Overall, 237 patients underwent EP-RPLND, of which 72% were administered in the postchemotherapy (PC) setting. Median follow-up was 16.7 months (interquartile range [IQR] 3.9-39.6). Median size of retroperitoneal disease was 2.8 cm (IQR 1.8-5.4), of which 16 cases were ≥ 10 cm. There were no cases of postoperative ileus or readmission due to small-bowel obstruction. Median hospital stay was 2 days (IQR 1-3). From 2020 to 2021, 73% of patients were discharged on postoperative day 1 and 89% by postoperative day 2. Thirty-one complications occurred, including 4% grade III to IV complications. In the primary setting, 2-year RFS for seminoma and nonseminomatous GCT was 0.93 (95% CI 0.84-1.00) and 0.85 (95% CI 0.72-1.00), respectively. In the PC setting, 2-year RFS for seminoma and nonseminomatous GCT was 0.88 (95% CI 0.74-1.00) and 0.88 (95% CI 0.81-0.95), respectively. Overall, only 7 patients had in-field recurrence. CONCLUSIONS Midline EP-RPLND is safe and associated with rapid gastrointestinal recovery, short hospital stay, and low complication rates. It also demonstrates acceptable oncologic outcomes in the primary and PC settings, with low rates of in-field relapse.

中文翻译：

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11 年生殖细胞肿瘤中线腹膜外腹膜后淋巴结清扫术经验。


目的 与经腹膜入路相比，腹膜后淋巴结清扫术 （EP-RPLND） 的中线腹膜外入路与发病率降低有关。我们旨在回顾我们在单一机构接受 EP-RPLND 的生殖细胞肿瘤 （GCT） 患者中的 11 年经验。材料和方法 回顾了 2010 和 2021 年接受 EP-RPLND 的所有 GCT 患者。报告了手术、围手术期和肿瘤学结局。开发了一个 logistic 回归模型来评估预测早期出院的变量。肿瘤学结局包括 2 年无复发生存期 （RFS） 和复发模式，根据病理学进行分析。结果 总体而言，237 例患者接受了 EP-RPLND，其中 72% 在化疗后 （PC） 环境中给药。中位随访时间为 16.7 个月 （四分位距 [IQR] 3.9-39.6）。腹膜后病变的中位大小为 2.8 cm （IQR 1.8-5.4），其中 16 例≥ 10 cm。没有术后肠梗阻或因小肠梗阻再入院的病例。中位住院时间为 2 天 （IQR 1-3）。从 2020 年到 2021 年，73% 的患者在术后第 1 天出院，89% 的患者在术后第 2 天出院。发生 31 例并发症，包括 4% 的 III 至 IV 级并发症。在原发性环境中，精原细胞瘤和非精原细胞瘤 GCT 的 2 年 RFS 分别为 0.93 （95% CI 0.84-1.00） 和 0.85 （95% CI 0.72-1.00）。在 PC 设置中，精原细胞瘤和非精原细胞瘤 GCT 的 2 年 RFS 分别为 0.88 （95% CI 0.74-1.00） 和 0.88 （95% CI 0.81-0.95）。总体而言，只有 7 例患者出现现场复发。结论 中线 EP-RPLND 是安全的，且胃肠道恢复快、住院时间短、并发症发生率低。 它还证明了在原发性和 PC 环境中可接受的肿瘤学结果，现场复发率低。