The present study is performed to determine whether retroperitoneal lymphadenectomy (rPLa) perioperative mortality (PM) rates reported from center of excellence [Indiana University: 0% for primary and 0.8% for postchemotherapy (PC) rPLa] are applicable to institution at large. Between 1975 and, 327 assessable patients with nonseminomatous testicular tumors (NsTT) were treated with rPLa: primary in 134 (41%) and PC-rPLa in 193 (59%) patients. The observed PM rates were stratified according to age, clinical stage (Cs) and type of rPLa. The median age at rPLa was 28 years (range 16-54) : < 29 years in 194 (56.3%), 30-39 years in 90 (30.3%) and > 40 years in 44 (13.4%) patients. Of 327 rPLa patients, 81 (27.8%) were performed for localized (Cs-I), 179 (54.7%) for regional (Cs-II) and 57 (17.5%) for metastatic (Cs-III) disease. Ten (3.1%) patients died during initial 90 days after rPLa: 1 patient from pulmonary embolism, 2 of chemotherapyrelated toxicity and 7 of progressive disease due to preoperative worse prognostic factors. Of the entire cohort 30, 60 and 90-day PM rate was 0.3%, 1.0% and 1.3%, respectively. PM rate increase with increasing age: < 39 years 0%, 30-39 years 5.0% and > 40 years 9.3% (x2 trend test, P= 0.002). PM rate also increased with Cs: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p<0.001). PM rate at primary and PC-rPLa was increased with Cs: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p<0.001). PM rate at primary and PC-rPLa was 0.7% and 3.1% 9P<0.001). rPLa was associated with virtually no or low (2.8%) PM rate in patients with localized and regional disease, respectively. In contrast, the PM rate of 8.8% for patients with distant metastases and group > 40 years of age (9.3%) implies that rPLa for these patients ApstraktCilj ove studije je da se odredi koliko perioperativni mortalitet (PM) posle retroperitonealne limfadenektomije (rPLa) iznet od strane iskusnih centara (Indiana University: 0% kod primarne i 0.8% kod posthemioterapijske (PH) rPLa) se može primeniti kod institucija u širem smislu. U periodu od 1975. do 2005., 327 pacijenata sa neseminomskim tumorima testisa (NsTT) je lečeno pomoću rPLa: primarna kod 134 (41%) i PH-rPLa kod 193 (59%) pacijenata. Učestalost PM je analizirana u zavisnosti od godina starosti, kliničkog stadijuma (Ks) i tipa rPLa. srednje životno doba pri rPLa je bilo 28 godina (raspon 16-54): < 29 godina kod 194 (56.3%), 30-39 godina kod 90 (30.9%) i > 40 godina kod 44 (13.4%) pacijenata. Od 327 učinjenih rPLa. 81 (27.8%) su učinjene kod pacijenata u Ks-I, 179 (54.7%) u Ks-II i 57 (17.5%) u Ks-III bolesti. deset (8.1%) pacijenata je umrlo tokom inicijalnih 90 dana posle rPLa: 1 pacijent od embolije pluća, 2 od toksiciteta hemioterapije i 7 od progresije bolesti zbog prisustva loših perioperativnih faktora rizika. Učestalost PM na 30, 60 i 90 dana u celoj grupi pacijenata je iznosila 0.3%, 1.0% i 1.3%, respektivno. PM je imao tendenciju rasta sa porastom godina starosti: < 29 godina 0%,...
ApstraktCilj ove studije je da prospektivno analizira incidenciju tumora germinativnih ćelija testisa (TGĆT) u zavisnosti od kliničkog stadijuma (Ks) i histologije, pošto se učestalost ovih malignoma uvećava. Pacijenti sa dijagnozom TGĆT između 1976 i 2005 su podeljeni u 3 vremenska perioda u zavisnosti od datuma dijagnoze TGĆT i određenih karakteristika pri prezentaciji. U cilju svrsishodnosti analize, pacijenti su podeljeni u 1 od 3 slične grupe u pogledu trajanja opservacije (10 godina) (1976-1985, 1986-1995, 1996-2005). Ova 3 perioda su statistički poređena da bi indentifikovali moguće promene u prezentaciji TGĆT. Od 1935 pacijenata, broj dijagnostikovanih u svakom periodu je bio 111(6%), 695(36%) i 1129(58%). Postoji značajan porast procenta pacijenata sa TGĆT tokom perioda od 30 godina, posebno u trećoj u odnosu na drugu i prvu dekadu (P<0.0001). Ukupno, 46% pacijenata je dijagnostikovano sa seminomom i 54% sa neseminomskim tumorom. Veliki procenat od ukupnog broja pacijenata sa TGĆT se prezentirao u Ks I (64%). seminomski i neseminomski tumori su imali veću učestalost u Ks I (78% prema 51%). srednje starosno doba za celu grupu pacijenata je bilo 34 godine. srednje životno doba sa metastatskim seminomom je bilo 4 godine veće nego u Ks I bolesti (42 prema 38 godina), dok je starosno doba u meastatskom i Ks I neseminomskih tumora bilo indentično (31 godina). Učestalost seminoma se vremenom značajno povećavala (40% prema 55%), što je praćeno značajnim smanjenjem učestalosti neseminomskih tumora (60% prema 45%) (P<0.001). Procenat pacijenata u Ks I se takođe značajno vremenom povećao (45% prema 77%), dok se procenat pacijenata sa metastatskom bolešću smanjivao (55% prema 32%)(P<0.001). Postoji značajan porast procenta pacijenata u Ks I seminomskih (27% prema 47%)(P<0.01) i neseminomskih tumora (18% prema 30%)(P<0.01), praćenih sa značajnim smanjenjem metastaskih neminomskih tumora (42% prema 15%)(P<0.001). Međutim, procenat AbstractThe aim of the present study is to prospectively investigate the presentation of germ cell testicular tumors (GCCTs) in terms of clinical stage (Cs) or histology, as the incidence of this malignancy in increasing. Patients diagnosed with GCTTs between 1976 and 2005 were categorized into 3 period depending on date of diagnosis of GCTTs and presentation characteristics assessed. For purpose of analysis patients were assigned into 1 of 3 similar groups in term of duration (10 years) (
The biological potential of teratoma remains unpredictable, therefore identifying its presence in the retroperitoneum remains important. We evaluated patients undergoing post-chemothe rapy retroperitoneal lymphadenectomy (PC-RPLA) for nonseminomatous testicular tumors (NSTT), to determine predictors of teratomatous elements in the retroperitoneum. We identified 161 patients from 1982 to 2005 who underwent PC-RPLA for metastatic NSTT. Multiple clinical and pathological variables were reviewed from out RPLA database. Of the 161 patients in our series, 112 (70%) received only induction chemotherapy and 49 (30%) required 2nd line chemotherapy. Studies of retroperitoneal pathology demonstrated the presence of fibrosis in 44 (27%), teratoma in 82 (51%) and vital carcinoma in 35(22%).Among 82 patients (51%) with finding of teratomatous elements at PC-RPLA, we revealed the presence ofmature teratoma in 85%, immature teratoma in 12% and teratoma with malignant transformation in 3%. Of the 99 patients (61%) with teratomatous elements in the primary NSTT, 61 (62%) had teratoma at PC-RPLA. Even in the absence of teratoma in the primary NSTT, teratoma was present in the retroperitoneum in 21 of 62 patients (32%)(p<0.0001). All patients had normal values of serum tumor markers (STM) at PC-RPLA. Post-chemotherapy retroperitoneal residual mass measuring <2 cm, from 2.1-5.0 cm and > 5 cm in diameter occured in 30%, 52% and 55%, respectively. By multivariate analysis , teratoma in the orchiectomy specimen (p<0.005), relative change in nodal size before and after chemotherapy (p<0.005), and no requirement for 2nd line chemotherapy (p=0.33) were independent predictors for the presence of the teratoma in the retroperitoneum. Teratoma remains
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