Laparoscopic retroperitoneal lymph node dissection for high-risk pediatric patients with paratesticular rhabdomyosarcoma.

Background and Purpose: Retroperitoneal lymph node dissection (RPLND) is recommended in children 10 years or older with paratesticular rhabdomyosarcoma (PTRMS). Primary tumors >5 cm are an additional risk factor for disease recurrence in the retroperitoneum. We report our experience with laparoscopic RPLND (LRPLND) in high-risk pediatric patients with PTRMS. Patients and Methods: Three patients, mean age 13.6 years ( range 10-16 yrs), underwent modified template LRPLND after radical orchiectomy for preoperative rhabdomyosarcoma stage T1aN0M0, T1bN0M0, and T2bN0M0, respectively. Primary paratesticular masses measured a mean 7.5 cm ( range 4-10 cm). LRPLND was performed a mean of 8.6 days ( range 7-12 d) after radical orchiectomy using four trocars that were placed equidistant in the midline. Results: Average operative time was 382 minutes ( range 245-656 minutes). Mean estimated blood loss was 53mL ( range 10-75 mL), and mean postoperative hospital stay was 2.5 days ( range 2-3 d). There were no postoperative complications. Retroperitoneal nodes had negative findings for microscopic disease in two patients and positive findings in one patient. All patients received adjuvant chemotherapy with vincristine, actinomycin, and cyclophosphamide. Conclusion: LRPLND for high-risk pediatric patients with PTRMS is a safe diagnostic and therapeutic procedure with the benefit of rapid convalescence, enabling early commencement of adjuvant chemotherapy.