Midline Extraperitoneal Approach for Retroperitoneal Lymph Node Dissection for Testicular Germ Cell Tumor

Kim, Philip; Syan-Bhanvadia, Sumeet; Djaladat, Hooman; Faber, Ken; Tadros, Nicholas N.; Nichols, Craig R.; Daneshmand, Siamak

doi:10.1016/j.urology.2012.07.006

Cited by 18 publications

(17 citation statements)

References 23 publications

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“…Five PC‐RPLND were carried out through a midline extraperitoneal approach we previously described, and a nerve‐sparing technique was utilized in six cases . All other cases were carried out through a standard midline intraperitoneal or modified thoracoabdominal approach.…”

Section: Resultsmentioning

confidence: 99%

Growing teratoma syndrome: Clinical and radiographic characteristics

et al. 2014

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Abbreviations & AcronymsObjectives: To present an overview of our surgical experience in the management of growing teratoma syndrome. Methods: A retrospective analysis of all patients undergoing post-chemotherapy retroperitoneal lymphadenectomy between November 2005 and February 2012 revealed 15 patients who met the criteria for growing teratoma syndrome. Their clinical data, imaging characteristics, and surgical and oncological outcomes were reviewed. Results:The median age at diagnosis was 23 years. Primary testis tumors included nonseminomatous germ cell tumor in 12 of 15 patients, seminoma in two of 15 patients and hemorrhagic mass in one patient. Mature teratoma was present in just six (40%) of the orchiectomy specimens. All patients received preoperative chemotherapy. On imaging, the median size of the largest retroperitoneal mass was 7 cm (range 3.9-24.5 cm). The median rate of linear growth was 0.5 cm/month (range 0.03-2.9), and the increase in volume was 9.2 cm 3 /month. All tumors were found to have cystic and necrotic components. Median operative time was 6.2 h (range 4.2-15.2 h). Estimated blood loss was 600 mL (range 100-7000 mL), and median length of stay was 5 days (range 3-19 days). Four patients required resection of non-retroperitoneal growing teratoma masses after post-chemotherapy retroperitoneal lymphadenectomy to achieve tumor-free status. There were two minor (Clavien I-II) and two major postoperative complications (Clavien ≥III). All patients are alive and disease free with a median duration of follow-up of 8 months (range 1-64 months). Conclusions: Growing teratoma syndrome tumors vary in their growth rate, but they all appear to have cystic features with necrosis elements on radiographic evaluation. Aggressive surgical excision is associated with excellent outcomes.

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Section: Resultsmentioning

confidence: 99%

Growing teratoma syndrome: Clinical and radiographic characteristics

et al. 2014

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“…28 The appeal of RPLND for this disease is that it offers a treatment with a significantly different side effect profile than that of EBRT and CT. RPLND has been used to treat germ cell tumors since the 1900s, and ample data are available on its long-term efficacy and safety. 16,[29][30][31] Surgery has not been associated with the development of cardiopulmonary disease, secondary malignancy, or metabolic syndrome. The use of RPLND to treat stage I NSGCT has been associated with a lower risk of secondary malignancy development.…”

Section: Discussionmentioning

confidence: 99%

“…This approach remains limited to specialized centers, although modifications to the open technique, such as the midline extraperitoneal approach, have been shown to similarly improve the short-term outcomes. 16 Because it is difficult to draw conclusions from the outcomes of a small number of patients with a relatively short follow-up period (25 months), our group plans to expand on the present series by starting a multi-institutional phase II trial. We are planning a study of RPLND as a front-line treatment of testicular pure seminoma with isolated low volume retroperitoneal disease (< 2 cm).…”

Section: Discussionmentioning

confidence: 99%

“…16 All patients underwent a modified template RPLND. For a right-sided testicular tumor, the limits of dissection were as follows: lateraleright ureter; medial superior to the inferior mesenteric arteryeleft ureter; medial inferior to the inferior mesenteric arteryeanterior abdominal aorta; superiorerenal vessels; and inferioreright common iliac artery just caudal to its bifurcation.…”

Section: Methodsmentioning

confidence: 99%

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Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma

Shah

Shojaei

et al. 2015

Clinical Genitourinary Cancer

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“…Antegrade ejaculation was maintained in 91% of patients with a nerve-sparing approach. The push for performing a laparoscopic RPLND may not have a profound impact on decreasing morbidity, as Kim et al [13] demonstrated that a midline extraperitoneal RPLND resulted in improvements in blood loss, operative time, length of stay (median 3.3 days) and lymph node counts when compared with a matched transperitoneal cohort. In the largest published study to date, Steiner et al [11 && ] examined outcomes in 100 patients who underwent laparoscopic PC-RPLND.…”

Section: Minimally Invasive Retroperitoneal Lymph Node Dissectionmentioning

confidence: 99%

Lymphadenectomy for testicular, penile, upper tract urothelial and urethral cancers

Djaladat

2015

Current Opinion in Urology

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A thorough LND has an established diagnostic and therapeutic role in testicular and penile cancer. For upper tract urothelial carcinoma, the role of an LND remains controversial, though emerging evidence points to an association with improved outcomes. Due to the rarity of urethral cancer, there are no standard LND templates, though excising clinically positive nodes is recommended. For all these cancers, more sophisticated risk stratification based upon clinical and pathologic factors has helped determine which patients require an LND and how to best manage these patients after surgery.

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Midline Extraperitoneal Approach for Retroperitoneal Lymph Node Dissection for Testicular Germ Cell Tumor

Cited by 18 publications

References 23 publications

Growing teratoma syndrome: Clinical and radiographic characteristics

Growing teratoma syndrome: Clinical and radiographic characteristics

Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma

Lymphadenectomy for testicular, penile, upper tract urothelial and urethral cancers

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