Minimally invasive lymph node dissection offers excellent outcomes in testis Ca cases

Minimally invasive retroperitoneal lymph node dissection in cases of testicular cancer produces excellent outcomes and reduces length of stay, according to a nationwide study conducted by urologists at the University of California, San Diego. The study compared the minimally invasive procedure to the standard open procedure.

These findings come with a few caveats, said first author Seth Cohen, MD, who worked on the study with Ithaar H. Derweesh, MD, and colleagues.

"First, this is not a common disease. The studies to date have been relatively few surgeons at high-volume centers," Dr. Cohen told Urology Times. He also noted that the study contained a selection bias in that patients undergoing the minimally invasive procedure tended to be healthier as evidenced by Charlson scores.

The researchers looked at a cohort of 7,079 men in the U.S. Nationwide Inpatient Sample between 1998 and 2009. The sample included 6,926 men undergoing the open procedure and 153 undergoing the minimally invasive procedure. The median length of stay for patients undergoing open dissection was 5 days compared to 2 for the minimally invasive procedure (p

Dr. Cohen also noted that there appeared to be a slight annual increase in the number of minimal procedures: about 1 to 2 per year.

"Outcomes are excellent, but this is a challenging procedure. It is not something to be picked up during a weekend course," he said.

The small numbers and selection bias suggest the need for a larger, prospective nationwide study, he said, adding that he knew of no such study being planned at this time.

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