To evaluate the effect of laparoscopic approach during RPLND in patients with TGCTs on the oncological and functional outcomes.

From 2014 to 2023, LS-RPLND was performed on 189 patients at The N.N. Petrov National Medicine Research Center of oncology, including 67 laparoscopic surgeries in patients with disseminated TGCT after chemotherapy. Median age was 33±9.1 years. Patients with seminoma accounted for 9%, non-seminoma - 91%. Distribution by stages: Stage IA - 5 (7.46%); IB - 3 (4.48%); IS - 5 (7.46%); IIA- 31 (46.27%); IIB - 18 (26.87%); IIC - 5 (7.46%). The good prognosis group IGCCCG included 47 patients (70.15%), intermediate — 17 (25.37%), unfavorable — 3 patients (4.48%). The sizes of retroperitoneal lymph nodes by the maximum length in the axial plane: up to 2 cm - in 26 (38.8%) patients; up to 3 cm - 24 (35.8%); up to 4 cm - 14 (21%); up to 5 cm - 1 (1.4%); up to 6 cm - 2 (3%). According to CT: regression <50% with a decrease in size to 2 cm was noted in 50 (74.6%); up to 3 cm - 17 (25.4%).

10-year OS of 67 patients was 96.3%. Median OS was 35.9±5.7 months. RFS 94.4% with a median of local recurrence after 19.8 months. Progression occurred in 6 cases (9%). The median to progression was 18.4±3.6 months. Metastasectomy after LS-RPLND was performed in 6 patients (9%): brain 2 (3%) and lungs 4 (6%). No significant effect of metastasectomy on OS (p<0.91), RFS (p<0.93) and time to progression (p<0.65) was found. The median duration of LS-RPLND was 195±75.9 min. Average blood loss was 380±159 ml.

There was a tendency towards a decrease in the incidence of complications (p=0.032) and a significant decrease in the risk of reoperation (p=0.031) after accumulating experience with LS-RPLND interventions, as well as the introduction of the fast track strategy since 2017.

LS-RPLND allows to achieve oncological results similar to laparotomy, and also leads to a decrease in the need for pain relief in the postoperative period, early rehabilitation, improving aesthetic properties and significantly reducing the duration of hospitalization.