Our newest appointment

[Scott]

I stumbled across this page again on the Sloan web site, which says, "[RPLND] is traditionally performed through a midline abdominal incision; however, studies are being performed to evaluate the efficacy of a minimally invasive laparoscopic approach (in which doctors perform the operation through several small incisions in the abdomen), which may reduce potential complications and shorten recovery time."

[Scott]

When I was investigating surgical options, Sheinfeld himself said that mortality rate of LRPLND is up to 6 times higher than classic open surgery. Also, there are more lost kidneys with LRPLND.

I'd just like to see data to support that, because I haven't seen that reported anywhere, and I don't understand why it would be true.

[boyce]

LPRLND vs. classic RPLND

When I was investigating surgical options, Sheinfeld himself said that mortality rate of LRPLND is up to 6 times higher than classic open surgery. Also, there are more lost kidneys with LRPLND. I'm telling Y'all that I researched the heck out of this thing. Open surgery was right for me, but lap may be better solution for others. One of my complicating factors was that I was post chemo and had the "stickiness" of the tomors attached to nerves, etc.

Certainly invesigate all options, and all I know is my experience. The open surgery IS painful and it is a major surgery. But the LRPLND is very new with a limited number of experienced surgeons.

For whatever that's worth....

[Scott]

I think you're merging the oncologist and the urologist treating Becki's husband into one person, but I can't argue with the main point: it's necessary to get to an oncologist with testicular cancer expertise right away.

[Scott]

The bigger question here is whether it's better to do RPLND now, because it might be teratoma and it's easier to perform RPLND before chemotherapy.

Becki, you must be incredibly eager just to get a good decision made, whatever it turns out to be!

[Scott]

...neither IU or Sloan do the LRPLND.

I remember reading in this bulletin from June 2005 that Sloan planned an L-RPLND study:

For example, attention is being focused on whether laparoscopic surgery for RPLND is as effective as the current "open" surgery approach. Dr. Joel Sheinfeld, vice chairman of Urology at Memorial Sloan-Kettering Cancer Center, observes that this new approach remains subject to debate: "It's unclear what is the therapeutic efficacy of laparoscopic surgery as compared with open RPLND, where the therapeutic efficacy is well established," he says.

Memorial Sloan-Kettering plans to initiate a study of the less invasive RPLND technique, Dr. Sheinfeld continues. "We're going to do a study of the laparoscopic operation so that it exactly mimics the open operation. This will be for patients with low-stage, seminoma stem cell tumors. Patients with low-volume disease will not get chemotherapy."

[Scott]

...but current NCCN guidelines specify the open approach.

Specifically, those guidelines say:

In general, an open nerve-sparing RPLND rather than a laparoscopic RPLND is recommended for therapeutic purposes. For example, a concern exists that a laparoscopic RPLND may result in false-negative results caused by inadequate sampling, and no published reports focus on the therapeutic efficacy of a laparoscopic dissection. Because the recommended number of cycles of chemotherapy is based on the number of positive nodes identified, inadequate sampling may lead to partial treatment.

[Scott]

I live in Hawaii and I came to Denver to have an open RPLND done in the University of Colorado by Dr. Shandra Wilson two weeks ago and I couldn't feel better.

Congratulations, and welcome to the forums!

[dadmo]

I don't understand where the "much higher mortality rate" idea comes from. Dr. Sheinfeld at Sloan has done more then 100 RPLND's per year for the past few years and has never lost a patient on the table. I believe the higher risk for LRPLND is that they might miss a bad node not that you will expire on the table.

[Scott]

lap RPLND is the easiest surgery????????

Open RPLND is hard, and laparoscopic RPLND is harder. I suspect he meant easier recovery for the patient, not easier operation for the surgeon.

[Scott]

Much higher mortality rate, more complications from surgery.

While there are reasons to favor open surgery, I don't believe this statement is true.

[pvarela07]

Becki,

I live in Hawaii and I came to Denver to have an open RPLND done in the University of Colorado by Dr. Shandra Wilson two weeks ago and I couldn't feel better. The University of Colorado also have great urologists and oncologists specialized in testicular cancer. I would contact them to avoid all the hassles of getting surgery or treatment away from home. Below is their contact information, best of luck.

Tiffany Colvin, Testicular cancer coordinator, 720.848.0664
Dr. Shandra Wilson, Urology, 720.848.1800
Dr. Thomas Flaig, Oncology, 720.848.0170

[mercyriver]

Yeah, I kind of picked that up before that IU doesn't recommend or do L-RPLND. I am fairly certain they will say chemo first.

Which honestly is better for us as a family too. We would have to fly somewhere with out knowing anyone there. With three young children even if they stayed home with someone, well just not the best option.

How ever it turns out we have lots of great family and friends here in Denver that will be great help for anything that occurs here.

And yes, my opinon of the urologist dropped a bit today. Good news is he is the top urological surgon in the state and has done pleanty of RPLND's. He just doesn't like the risks involved in doing surgury after chemo. He says everything is much more delicate and he has had men that everything you touch bleeds. He was just trying to find the easiest surgury. But as my husband put it, he wants what is best for him, not for the surgoun.

Becki

[mikeygti]

With enlarged lymph nodes,and a large component of E/C in the original tumor,he should be headed for Chemo. Surgery would then be required to remove any remaining masses >1cm .

I would be surprised if Einhorn suggested anything different.

Best of luck !

[dadmo]

Now that IU will be involved things should move quickly. It won't take Dr. E. long to make a decision but as boyce mentioned neither IU or Sloan do the LRPLND. I don't have a problem if you choose the LRPLND just make sure your not his first and that if he needs to he will go to a full open.