DISCOVERY IN TESTICULAR CANCER
Early-Stage Testiscular Cancer: A Laparoscopic Improvement in Treatment
When a man is diagnosed with early-stage testicular cancer (specifically, a nonseminomatous germ cell tumor), his treatment choices include active surveillance, chemotherapy, or a procedure called primary retroperitoneal lymph node dissection (RPLND), removal of the lymph nodes to make sure the cancer has not spread. But RPLND is major abdominal surgery. Thus, "more recently, active surveillance has become the most favored management strategy," says urologist Phillip Pierorazio, M.D., "given the uncertain, long-term side effects of chemotherapy and the short-term side effects of RPLND." However, men who fail active surveillance are often restricted to chemotherapy as their only option for treatment.
"In a disease that is 99 percent curable and with patients who have little surgical risk due to their young age and good general health, the argument could be made for aggressively treating men with low-stage disease with a minimally-invasive procedure."
Testis cancer generally affects young, otherwise healthy men, and — if it weren't such an arduous procedure — RPLND could eliminate the need for a prolonged course of cancer surveillance or the long-term side effects of chemotherapy. "In a disease that is 99 percent curable and with patients who have little surgical risk due to their young age and good general health, the argument could be made for aggressively treating men with low-stage disease with a minimally-invasive RPLND," Pierorazio continues.
There is a more minimally invasive choice: Robot-assisted laparoscopic RPLND. "This procedure has been shown to offer better perioperative (during and immediately after surgery) outcomes when compared to the open operation, with the same degree of cancer control. However, it is a technically challenging procedure." Urologists Mohamad Allaf, M.D., and Pierorazio, who perform this operation, recently published the results of the Johns Hopkins experience and a comparison of laparoscopic and robot-assisted laparoscopic RPLND in the British Journal of Urology International. Kelly Harris, a medical student, future urologist, and the lead author of the study summarizes, "Our group has shown that robotic is comparable to laparoscopic, with the added benefits of better three-dimensional visualization and degrees of freedom to afford a better, minimally invasive cancer operation."