Introduction: We described a complex right post-chemotherapy laparoscopic retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ cell testis cancer.
Methods: Patient was a 17 years old male with no comorbidities and no previous surgery who had right orchiectomy in December 2020 for a right testis nodule. Preoperative tumor markers were negative. Definitive pathological specimen resulted in 10% seminoma and 90% teratoma. In January 2021 contract enhanced Chest and Abdominal CT scan was performed and multiple pulmonary lesions between 5 and 16 mm and retroperitoneal localization of 42x42x54 mm were found. Patient had 4 cycles of bleomicyn, etoposide and platinum from March to May 2021. In June 2021 CT scan was repeated and we found and increased volume of the retroperitoneal lesion (90x80x94 mm) with stable pulmonary disease.
Results: Patient underwent post-chemotherapy laparoscopic RPLND in July 2021. Operative time was 280 minutes with an estimated blood loss of 150 cc. No postoperative complications
were recorded and the patient was discharged in four days. Definitive pathological specimen resulted in post-pubertal teratoma. Finally, patient had two pulmonary resection in August and October 2021.
Conclusions: Laparoscopic RPLND when performed in high-experienced centers is an equivalent alternative to open surgery also in complex cases