Laparoscopic RPLND and surveillance questions

[ryan296]

I was diagnosed with TC and had a right I/O on 4/17/06. My doctors have scheduled me for an RPLND on 6/06/06. A lot of things I've read say you shouldn't really wait more than 6 weeks after the I/O for the RPLND because after that you've essentially entered the surveillance stage; that surgery date puts me at 7 weeks after the I/O. Does anyone know if the extra week is going to matter? After reading some of the posts on here it seems like some people have waited longer. Should I go ahead with the RPLND or cancel it and just go with surveillance?

Also I was wondering how many people who have had the RPLND had it done laparoscopically? My doctors said they would try doing it that way. But a lot of the things I've read about it say it is not very good for therapeutic reasons rather it would just be to see if metastatic disease is present. And it also seems like it's still in a research stage. Maybe I'm not fully understanding this and sorry if I'm not making sense; but is it right to say the doctors would go in laparoscopically and if they see any metastasis they will convert to an open RPLND? Has anyone had one done laparoscopically?

Thank you in advance for any advice. This site has been really helpfully and it has been great to read about everyone's experiences.
Thanks,
Ryan

Rt I/O 4-17-06
40% Embryonal, 40% teratoma, 10-15% Yolk Sac Tumor, and 5-10% Seminoma

[dadmo]

Ryan:
Scott had his RPLND done laparoscopically, you may want to check this thread http://tc-cancer.com/forum/showthread.php?t=2173. waiting 7 weeks from the I/O should have no impact. My only question is has your doctor ever done an LRPLND? I wouldn't be comfortable if I was the first.

[Fish]

Hi Ryan:

When I had my first case of TC in 1988 it was about 8 weeks between my I/O and my RPLND (all of these were open back then). Dadmo makes an important point, has your surgeon ever done Lap RPLND? You definitley want someone with experience doing this procedure.

Surveillance might also be an acceptable option. I'm assuming that your CT scans and blood work are normal? You could always contact another doctor to get a second opinion on what approach to take. Whatever you decide, chances for a complete cure are excellent.

best wishes,

Jim

[DianeE]

Hi Ryan,

When my son had his consultation with the surgeon for the RPLND,
he told us he had conferences the last part of May, but would try
to schedule Brian in. I asked him about the 6 week time span between
the I/O and the RPLND, and he said 6 weeks or so, but didn't make
it sound like a few extra weeks would make a difference. We were
lucky because he was able to schedule Brian three days later due to
a cancellation and Brian is home recuperating now.

Dadmo, as always, made a great point. Make sure the surgeon
has experience in whichever surgery you have done.

Good luck with it. It will all be behind you soon.

Diane

[tccancercop]

Ryan, I would have it done if possible. Remember, if not the cancer WILL come back. It hides in the lymph nodes. I was told it appereared to not spread after my R/O. A few weeks later my AFP jumped above normal.. .then it was chemo.. Well now its spiked up again!!!! I should have done an RPLND!!!! I have the option of an LRPLND if I need it at Cleveland I believe. Just take all the preventive steps now!

[dadmo]

Ryan:
My opinion on LRPLND vs. Standard RPLND is that if having you opened for a better view allows the surgon more opportunity to observe the affected area I would opt for the open RPLND. It's something that really needs to be discussed with your doctor. It is also my understand that if you choose LRPLND and the frozen section indicates active disease they will revert to a full open. That being said I think they were suspect about disease in Scott but rather then go to an open they simply made a few more entry marks for better access.

[ryan296]

Thank you

I'm in the process of switching hospitals right now and haven't had the chance yet to meet with the doctor that is scheduled to do my RPLND. I will certainly make sure he has some experience with doing it laparoscopically and ask him about the potential problems with it. The big thing I was worried about was that it was outside that six week time frame. But yes my ct scans and blood work are looking good. Thanks everyone for sharing your opinions and experiences.
tccancercop, I'm sorry to hear that your AFP levels have jumped again. So what do the doctors suggest you do? Good luck to you.

[Scott]

I have more to say on this but am still catching up from traveling and have to hurry off to work. My short answer is that I would be seriously considering surveillance if you were stage I, your imaging tests are all clear, and your markers have normalized.

[MRM]

There are pros and cons to each side. You'll get a larger amount of radiation through CT scans over the years of surveillance, which slightly raises the risk of another cancer in the future, but 70% of stage 1 patients are cured by the orchiectomy.

Some people are constantly worried they still have cancer in their bodies without the RPLND.

Either way, know you will be fine.

[ryan296]

Surveillance at Stage I instead of RPLND

Scott,
Can you please elaborate a little more on your thinking about surveillance instead of RPLND when in Stage I? That seems like it goes against pretty much everything else I've read and what my doctors are saying. I know it is an option but it seems like everything says it would be best to go ahead with the RPLND.
Thanks,
Ryan

[Scott]

Are they explaining why? 70% of stage I non-seminoma survivors are cured by the orchiectomy alone. I suspect they're using laparoscopic RPLND as a staging technique, and it's major surgery to go through just for that purpose. Be sure to read the TCRC pages on RPLND and surveillance.

[Scott]

But a lot of the things I've read about it say it is not very good for therapeutic reasons rather it would just be to see if metastatic disease is present. And it also seems like it's still in a research stage. Maybe I'm not fully understanding this and sorry if I'm not making sense; but is it right to say the doctors would go in laparoscopically and if they see any metastasis they will convert to an open RPLND?

It is possible for laparoscopic RPLND surgery to be curative. While it is true that conversion to open surgery sometimes occurred when positive lymph nodes were found, it has become more common to complete the surgery laparoscopically, and more recently to continue surveillance rather than administer adjuvant chemotherapy afterward. This is still relatively unproven, but I took the risk when I had my recurrence last year.

Be sure to read Karen's recent post in the Research Library.

[ryan296]

Okay, thanks that just gives me more options and things to talk to the other doctor about. I have an appointment scheduled 5-31 to get a second opinion and I'm definetly going to ask more questions if they think I should still do the RPLND.

[Scott]

If you don't already have enough questions about RPLND on your list -- -- there are more on this TCRC page.