Quality of Life and Pain Control following Laparoscopic Retroperitoneal Lymph Node Dissection in Early-stage Nonseminoma. Issue 6 (November 2015)

• Record Type: Journal Article
• Authors: Nicolai, Nicola; Bianchi, Elisabetta; Donati, Ilaria; L'Acqua, Camilla; Brunelli, Cinzia; Biasoni, Davide; Catanzaro, Mario; Stagni, Silvia; Piva, Luigi; Torelli, Tullio; Necchi, Andrea; Raggi, Daniele; Giannatempo, Patrizia; Faré, Elena; Colecchia, Maurizio; Langer, Martin; Borreani, Claudia; Salvioni, Roberto
• Is Part Of: Tumori. Volume 101:Issue 6(2015)
• Page Start: 650
• Page End: 656
• Publication Date: 2015-11
• Subjects: Clinical outcome -- Germ cell and embryonal -- Neoplasms -- Pain management -- Quality of life -- Testis neoplasms; Cancer -- Periodicals; 616.994
• DOI: 10.5301/tj.5000354
• Languages: English
• ISSNs: 0300-8916

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.