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Stage IIA : Laranscopic vs Open RPLND?

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  • Stage IIA : Laranscopic vs Open RPLND?

    Hi there,

    Firstly thanks for everyone's input on the forums, it's been hugely helpful and I'm grateful for this community.

    I am a 36 year old based in New York City and just got diagnosed with Testicular cancer last week Tuesday. Most likely non-seminoma/or mixed stage II (1 left retroperitioneal/periaortic lymph node measured 1.3 x 0.8 x 1.6cm). I am still waiting for the second pathology from my orchiectomy and a Lung CT scan (I had a CT of my abdomen which detected the abnormal lymph node) before my treatment plan next week.

    My AFP marker was 7.7 prior to the removal of my left testie and went down to 7.1 after the removal (tested a week after the surgery). Other markers were all within range prior to the removal.

    I met with MSK a few days ago and they mentioned that they will most likely have to do open RPLND surgery istead of/before chemo and I have a meeting with a surgeon next week. They do not offer laporoscpic RPLND at MSK.

    I appreciate I am jumping ahead of the final results, I feel blessed to be being seen by MSK and the talented team there and I obviously want to be cured buu I want to consdier all options available. I have been researching laranscopic RPLND and wanted to ask a few questions. I would appreciate anyone's advice :

    1) are there any recent studies or papers comparing the success rates of Laparoscopic vs Open RPLND?

    2) in the US, who would be the best & most experienced Laparoscopic RPLND surgeon/s?

    3) are there any stage llA non-seminoma patients that have done Laparoscopic RPLND that could share their honest thoughts? I obviously would value anyone's input too.

    THANK YOU KINDLY!
    Doug

  • #2
    Hey Doug, just quickly, I would strongly recommend a bilateral open RPLND. The node yields removed are significantly higher than in the lap-robotic method. I have seen too many people do the robotic approach and have small numbers of lymph nodes removed and then relapse. Go with Sheinfeld and go full throttle with his recommendations.
    Diagnosed at age 31. Treated in NYC. Now living in Ottawa, ON, Canada.

    7/1/2015: felt tiny lump on side of R testicle
    7/30/2015: Ultrasound shows 2 intra-testicular masses.
    7/31/2015: tumor markers normal, CXR clear
    8/5/2015: R orchiectomy
    8/11/2015: Pathology: 1.2 x 1.0 x 1.0 cm, embryonal 80%, seminoma 20%, with LVI and rete testis invasion
    8/14/2015: CT abdomen/pelvis clear, Stage 1b
    8/24/2015: started 1 x BEP

    Comment


    • #3
      Originally posted by RJKD View Post
      I have seen too many people do the robotic approach and have small numbers of lymph nodes removed and then relapse.
      Do you have any scientific evidence of this statement? All papers that I have read reveal actually same percentage of relapse

      Comment


      • #4
        There has been at least one, maybe more members here that have done a laproscopic RPLND and then needed chemo later. But that is definitely not a scientific study.
        6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
        6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
        7/7/15: bHCG 56, AFP 42, LDH 322
        7/13/15 - 9/18/15: 4xEP
        10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
        10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
        4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
        4/20/16: RPLND @ IU - teratoma only!
        9/27/2018 all clears up to this date!

        Comment


        • #5
          Thank you everyone. I really appreciate the responses.

          @singa76 do you have any links of papers that you have read?

          @biwi do you know anyone that has done has done Lap-robotic RPLND? I would love to ask them about their experience.

          Comment


          • #6
            Link to previous discussions on this topic:
            http://www.tc-cancer.com/forum/forum...t-for-my-2a-ec
            http://www.tc-cancer.com/forum/forum...s-the-question

            Joe.schupe22 is the one who relapsed after primary robotic RPLND: http://www.tc-cancer.com/forum/forum...onal-carcinoma

            6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
            6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
            7/7/15: bHCG 56, AFP 42, LDH 322
            7/13/15 - 9/18/15: 4xEP
            10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
            10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
            4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
            4/20/16: RPLND @ IU - teratoma only!
            9/27/2018 all clears up to this date!

            Comment


            • #7
              Günter Janetschek and Reinhold P. Zimmermann, Diagnostic and Therapeutic Laparoscopic Retroperitoneal Lymph Node Dissection in Low-Stage Nonseminomatous GCC: The European View, in M.P. Laguna et al. (eds.), Cancer of the Testis, Springer-Verlag London Limited 2010

              Nicola Nicolai et el., Laparoscopic Postchemotherapy Retroperitoneal Lymph-Node Dissection Can Be a StandardOption in Defined Nonseminomatous Germ Cell Tumor Patients, JOURNAL OF ENDOUROLOGY Volume 30, Number 10, October 2016

              These are some of the references I had read. As a recommendation, I think the most important thing is the experience of the surgeon.

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              • #8
                I really think it depends. I would definitely get TWO opinions before going with robotic. The scar fades, and in my teenage son's case, his post chemo RPLND which was open saw a lot more Teratoma than was visualized on CT scans. Grant had 2 post chemo CT Scans before his open RPLND.
                Son Grant
                dx 12/21/16 at age 17

                BEP x3
                Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
                2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
                Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

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