Laparoscopic RPLND vs. Open RPLND

[danebert]

Yes, I would be glad to e-mail them to you. I have the full studies but I don't think I am alowed to post them here, in their full content because the full articles are not available to the public without purchase., only the abstracts.

[Scott]

Thanks, I'd appreciate that.

The thing I'm most curious about is the difference in interpretation regarding Dr. Einhorn's opinion.

Dr. Sheinfeld must believe there's promise in the laparoscopic approach, since Memorial Sloan-Kettering does plan a study. (See this article.)

[Mom]

I thought they did lap-RPLNDs routinely in Europe when they were done. I thought we (US) were the ones lagging in expertise in this area. Dianne

[Molars]

As a dentist, I've objectively engaged in a lot of research and read many studies about lap and open RPLND. I'm convinced that the lap RPLND is the proceedure for me. Granted, I've got no teratoma nor any metastasis. The reason I'm doing RPLND to begin with is that I want to avoid or minimize chemotherapy. At 28 years old, the long term risk of developing secondary malignancies from chemotherapy is a concern to me. Also, I want to be sure that the cancer is gone. I'm not satisfied with simply being observed. What I've discovered from talking to doctors is that the testicular cancer "experts" are not minimally invasive surgeons, and the minimally invasive surgeons are not "experts". You are either in one gang or the other and they are both flinging poo at each other. I believe that there are cases where lap might be better that open and visa versa. I'm comfortable with the studies I've read and confident in the ability of Dr. Porter, one of the nations finest lap RPLND surgeons. Granted more studies are needed, but what is out there suggests that in many cases, open is just as effective as lap. In medicine, as in dentistry, there is always incredible resistance straying from the status quo. The take home message is talk to MULTIPLE doctors, ask lots of questions, do lots of research and make an informed decision about your own treatment.

Ryan

[Molars]

By the way, I've just chugged a bottle of mag-citrate, gone the day without eating anything and am preparing for my operation tomorrow morning at 7:40am. My bowels are squeeky clean. Let you all know how it turns out... send me lots of prayers, karma, good luck etc. I'll let you know how it turns out.

[danebert]

good luck! Its too late now but just concider this . THe easiest route isnt always the best. Why did you choose the Lap over open. IN fact why did you chose the RPLND at all. COriocarcinoma spreads via the blood. Why would anybody? afraid about the pain?, WOrried about the scar?



also scott, which study would you like me to e-mail you.

[dadmo]

Molars:
Positive karma at ya.

[Scott]

Good wishes for successful surgery and a rapid recovery, Ryan!

[Molars]

Thanks all for the support. Lap RPLND is done. I was in the hospital over night and am back at my a hotel for a week. I feel pretty good, little abdominal soreness but up and walking around. The reason that I chose rplnd in the first place was to confirm the stage and lower the chance of getting chemo. All the doctors I spoke with stated that testicular cancer spreads via lymph nodes, not one was concerned about vascular spread. The open doctors wanted to do it open, Porter and Kavoussi wanted to do the lap. In the end, in my case, I completely believe Drs. Porter and Kavoussi in that the only difference between lap and open is the recovery period. But the bottom line was after reading all the research I came acoss it seems that rplnd is under appreciated as treatment for state I non seminoma. I didn't fear the open, if I felt it was truely the superior technique, I would have done it. I don't believe it to be the superior technique in my case. By the way, all the removed lymph nodes were negative! Kudos to Dr. Porter.

Ryan

[Scott]

Excellent news, Ryan! I'm glad to hear you're doing well, and especially that no cancer was found.

[Scott]

Do you have your surveillance schedule set yet? The TCRC recommendation calls for monthly tumor markers and chest x-ray in the first year after RPLND. What are you being told about CT scans?

[Don]

Glad to hear you are doing well Ryan and hope you have a speedy recovery. Thanks to all for educating me on the LAP-RPLND!!!!!!

[Mom]

Great news, Ryan.We are all very much interested in your recovery and your surveillance so please keep us informed. This was a great thread. Good debate. I am sure you are relieved. Now enjoy the holidays but don't overdo. Dianne

[dadmo]

That's great news Ryan, I just want to caution you, watch your diet. Stay no fat for a few weeks it will help the node ends repair themselves.

[Molars]

No retrograde ejaculation, 25 lymph nodes were removed, all confirmed negative. I did have one side effect. My right foot is always hot. Doctor says that it is a sympathetic response namely, vasodialation of the vessels in my right foot. My left foot compensates with vasoconstriction of the vessels. So my right foot is hot and sweaty, my left foot is cold and dry. Pretty interesting, don't really notice it all that much and doctor says it will eventually subside. Thanks for all the support!

P.S. New data is coming out supporting laparoscopic rplnd being equal to open. In this data, chemotherapy is not given after positive findings. Dr. Porter feels this is over-treatment. I am a firm believer in the laparoscopic procedure and am glad to share my experiences with anyone struggling to decide amongst treatment options. Feel free to send me an email. Happy holidays to all!