Long‐term oncological outcome after post‐chemotherapy retroperitoneal lymph node dissection in men with metastatic nonseminomatous germ cell tumour

Abstract

2002 in one institution. We reviewed the clinical, surgical and histological charts of 151 such patients who had a RPLND after first-line platinum-based chemotherapy. The recommendations used to define conformity to RPLND standards were: the indication based on initial and residual lymph node size, shrinkage, extension of dissection and completeness of resection. RESULTSRPLND conformed to standard recommendations in 70 of the 151 (46%) patients. Conformity was complete for the surgeon who operated on 48 patients and was 26% of the others. Fifteen patients (10%) relapsed in the retroperitoneum, 14 of whom had initial lymph nodes of ≥ 5 cm. Two patients (3%) relapsed in the group of 70 patients with conformed and complete RPLND, vs 13 (16%) in the 81 with conformed but incomplete resection or with non-conformed and complete or incomplete RPLND. After a median (range) follow-up of 77 (1.3-186.5) months 132 patients were alive with no evidence of disease, 18 died and one was alive with progressive disease. The limitations of this study were the relatively few patients and that it was retrospective. CONCLUSIONThere was conformity of RLNPD to the recommendations, and completeness of resection, in half of the patients operated; this might have an effect on oncological outcome. Our data suggest that patients should be treated in tertiary centres.

Post-chemotherapy retroperitoneal lymph node dissection in the management of metastatic testis cancer: the 16-year experience in an Irish setting

“…The 75-83 % accuracy achieved in some models still renders false negative rates too high to safely avoid RPLND in this setting. Our relapse rate after RPLND surgery is comparable to that of Flechon et al [25] at 18.5 % with median follow-up 6.1 months (range 1.3-39 months) post PC-RPLND. Regarding sites of relapse post RPLND, three patients did suffer relapse within the abdomen but these were outside the resection template.…”

“…Our overall survival (92.6 % at median 100 months) compares with that in Flechon's report (87 %, median follow-up 77 months and range 1.3-187 months) [25]. Similarly the 95 % 5-year survival rate in our series is reassuring because overall 5-year survival for all patients with testis cancer is reported at 97 % at 5 years [26].…”

Guidelines on Testicular Cancer: 2015 Update

“…In poor-prognosis nonseminomatous germ-cell tumours, overall survival (OS) within a clinical trial depends on the number of patients treated at the participating centre (poorer if fewer than five patients are enrolled) [3]. In the same context, the frequency of postchemotherapy residual tumour resection is associated with perioperative mortality and OS [4,5].…”

Kommentar zur retroperitonealen Lymphadenektomie – laparoskopisch vs. robotisch

“…Hintergrund dieser Empfehlungen ist eine erhöhte perioperative Mortalität von 6% nach PC-RPLA in Institutionen mit geringer Erfahrung vs. 0,8% in erfahrenen Zentren [24]. Des Weiteren liegt die prognostisch ungünstige lokale Rezidivrate aufgrund kompletter Tumorresektionen in erfahrenen Zentren mit 3% gegenüber 16% signifikant niedriger als in Institutionen mit geringer Expertise [25].…”

“…Hintergrund dieser Empfehlungen ist eine erhöhte perioperative Mortalität von 6% nach PC-RPLA in Institutionen mit geringer Erfahrung vs. 0,8% in erfahrenen Zentren [24]. Des Weiteren liegt die prognostisch ungünstige lokale Rezidivrate aufgrund kompletter Tumorresektionen in erfahrenen Zentren mit 3% gegenüber 16% signifikant niedriger als in Institutionen mit geringer Expertise [25].Voraussetzung für ein onkologisch optimales Ergebnis ist die komplette Resektion der Residualtumoren unter Berück-sichtigung der etablierten Dissektionsfelder, die insbesondere auch die dorsal der großen Gefäße gelegenen Regionen erfassen. Die Ausdehnung der Dissektionsfelder wird in der Literatur durchaus kontrovers diskutiert.…”