Quality of life and pain control following laparoscopic retroperitoneal lymph node dissection in early-stage nonseminoma

Aims and background: To evaluate postoperative pain (PoP) and quality of life (QoL) in patients undergoing open (0-) or laparoscopic (L-) retroperitoneal lymph node dissection (RPLND) for clinical stage I (CS I) and normal markers CS IIA nonseminomatous germ cell tumors. Methods: Since March 2010, a prospective nonrandomized trial evaluated dynamic and rest (R) numeric pain scale (NPS) following patient -controlled analgesia and baseline (TO), 3-month (T3), and 6-month (T6) QoL status assessed by Functional Assessment of Cancer Therapy -General (FACT-G) questionnaire and the Italian-validated Functional Assessment of Chronic Illness Therapy (FACT-T-SG) at T6. Secondary endpoints'included length of hospital stay (LHS), interval to recovery (ItR), complications, and oncologic outcomes. Results: In March 2012, 69 (64 CS I) patients were enrolled. Five patients only chose O-RPLND. The PoP and complete QoL data are available in 41 and 56 patients, respectively. The R-NPS significantly improved in days 1-2 vs day 0 (p<0.0008). The FACT -G scores improved from baseline: the emotional well-being scale was the most relevant at T3 (+7.0, p=0.0001) and T6 (+6.9, p=0.0002). The FACT-TS-G indicated high satisfaction levels. Median LHS and ItR were 3 and 15 days. Six complications required an intervention. Nodal metastases were found in 14 (20.3%) patients. Following a median follow-up of 36 months, 6 (8.9%) patients relapsed (2/12 among pN+), and 8 patients (11.9%) underwent chemotherapy. All patients maintained antegrade ejaculation and are alive and disease-free. Conclusions: Almost all patients chose L-RPLND, which is associated with a rapid improvement of postoperative pain; QoL scores improved up to 6 months. The L-RPLND may be considered as an alternative only when performed in highly experienced centers.