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

Abstract

Aims and background

To evaluate postoperative pain (PoP) and quality of life (QoL) in patients undergoing open (O-) 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 (T0), 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.

Tumori 2015; 101(6): 650 - 656

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/tj.5000354

Authors

Nicola Nicolai, Elisabetta Bianchi, Ilaria Donati, Camilla L’Acqua, Cinzia Brunelli, Davide Biasoni, Mario Catanzaro, Silvia Stagni, Luigi Piva, Tullio Torelli, Andrea Necchi, Daniele Raggi, Patrizia Giannatempo, Elena Faré, Maurizio Colecchia, Martin Langer, Claudia Borreani, Roberto Salvioni

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Testis Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy
  • Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy
  • Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy
  • Anesthesiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy
  • Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy
  • Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan - Italy

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