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

Considine, S.; Heaney, Roisin; Conroy, Ronán; Thornhill, John

doi:10.1007/s11845-015-1394-2

Cited by 11 publications

(17 citation statements)

References 24 publications

(25 reference statements)

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“…No patients died within 30 days and the highest reported Clavien–Dindo grade was IIIb with a frequency of 1.5%. This compares well with other contemporary series that show higher grade complications (Clavien–Dindo Grade III–IV) of 8.9% and overall complication rates of up to 9% . We acknowledge that there may have been variability in case selection, including the potential for a small number of men to have been deemed inoperable.…”

Section: Discussionsupporting

confidence: 82%

Contemporary retroperitoneal lymph node dissection (RPLND) for testis cancer in the UK – a national study

et al. 2016

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ObjectivesTo undertake a comprehensive prospective national study of the outcomes of retroperitoneal lymph node dissection (RPLND) for testis cancer over a 1-year period in the UK. Patients and MethodsData were submitted online using the British Association of Urological Surgeons Section of Oncology Data and Audit System. All new patients undergoing RPLND for testis cancer between March 2012 and February 2013 were studied prospectively. Data were analysed using Tableau software and case ascertainment compared with Hospital Episode Statistics data. ResultsIn all, 162 men underwent RPLND by 20 surgeons in 17 centres. The mean (range) case volume per centre was 9 (2-32) and the median (range) case volume per surgeon was 6 (1-30). Indications included: residual mass after chemotherapy (73%), primary treatment (6%), relapse (14%), and salvage (7%). The median time to surgery after chemotherapy was 8-12 weeks (<4 ->12 weeks) and 91% of procedures utilised open surgery. The median operating time was 3-4 h (<1.5 ->6 h). Nerve sparing was performed in 67% of patients (19% bilateral, 48% unilateral). The dissection was template in 81% and lumpectomy in 16%; 25% required additional intraoperative procedures including 11% synchronous planned nephrectomy. In all, 157/160 (98%) of recorded RPLND operations were completed. One was terminated due to bleeding and in two the mass could not be removed. There were no deaths within 30 days of surgery. In all, 75% of the men did not require a blood transfusion, 15% required 1-2 units and 10% received >2 units. There were postoperative complications in 10% of the men (ClavienDindo Grade I, seven men; Grade II, seven; and Grade III, one). The mean (range) length of stay was 5.5 (1-59) days. Histology showed necrosis in 22%; teratoma differentiated in 42%; and residual cancer in 36%. ConclusionsThis prospective collaborative national study describes for the first time the surgical outcomes after RPLND across the UK. The quality of RPLND in the UK appears high. The study can act as a benchmark for this type of surgery across the world.

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Section: Discussionsupporting

confidence: 82%

Contemporary retroperitoneal lymph node dissection (RPLND) for testis cancer in the UK – a national study

et al. 2016

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“…Nakamura et al 25 and Alanee et al 26 reported a probability of 9.0% and 43% for the presence of viable tumors, respectively, while several other studies have also reported viable tumors in 10%-40% of patients. [21][22][23][24][25][26][27] In our study, the frequency of viable tumors was 19.2%, similar to that observed in previous studies. Compared to earlier studies, recent studies have shown that the percentage of patients with residual cancer after chemotherapy has declined, which could potentially be related to the improved efficacy and delivery of chemotherapy.…”

Section: Resultssupporting

confidence: 92%

“…With respect to complications associated with RPLND after chemotherapy, Baniel et al 20 and Considine et al 21 reported complication rates of 18% and 29.5%, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, Djaladat et al 23 and Steiner et al 24 Therefore, additional surgeries following RPLND, such as nephrectomy, aortic replacement, vena cava resection, and ureter repair, may be necessary. 21 Djalada et al 23 reported that 30% of patients underwent additional surgery; 15% of patients underwent vascular surgery, and 14% underwent nephrectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Considine et al 21 reported that 28% of patients required further surgery including vascular surgery in 2.6% and nephrectomy in 20% of patients. In our study, adjuvant surgery was performed in 7 patients (26.9%); 11.5% underwent vascular surgery, and 3.8% underwent nephrectomy.…”

Section: Resultsmentioning

confidence: 99%

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Clinicopathologic and Oncological Outcomes in Korean Men With Advanced Metastatic Testicular Cancer Undergoing Postchemotherapeutic Retroperitoneal Lymph Node Dissection

Yuk

Kang

Lee

et al. 2017

Korean J Urol Oncol

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Purpose: To evaluate the clinicopathologic and oncological outcomes of advanced metastatic testicular cancer in Korean men who underwent retroperitoneal lymph node dissection (RPLND) following chemotherapy. Materials and Methods: Data of 26 patients with testicular cancer who underwent RPLND after chemotherapy at 2 hospitals in Korea between September 2004 and June 2016 were retrospectively analyzed. Clinical and histopathological variables such as stage of the testicular cancer, age of the patients during surgery, size of the retroperitoneal lymph nodes (RPLNs), histopathological results, duration and complications related to the surgery, cancer recurrence, and mortality were analyzed. Results: During testicular surgery, the T stage was pT1, pT2, and pT3 in 50% (n=13), 26.9% (n=7), and 15.3% (n=4) of the patients, respectively. Mixed germ cell tumor was the most common finding, seen in 73.1% (n=19) of patients. The indications for RPLND were residual lymph nodes after chemotherapy, 84.6% (n=22); and disease progression and remission, 7.7% (n=2). Pathological analysis revealed viable tumors in 19.2% of patients (n=5), necrotic/fibrotic tissue in 42.3% (n=11), and teratoma in 34.6% (n=9). Intraoperative and postoperative complications occurred in 23.1% (n=6) and 19.2% of patients (n=5). The median duration of follow-up was 27.5 months (interquartile range, 1.3-108.2 months); 11.5% (n=3) patients had recurrence, and 3.8% (n=1) died of progressive metastatic testicular cancer. Conclusions: Viable germ cell tumors were present in 19.2% of patients with testicular cancer who underwent RPLND after chemotherapy. This is the first study of its kind in the Korean population.

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Additional surgical procedures and perioperative morbidity in post-chemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer in two intermediate volume hospitals

et al. 2020

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Purpose To evaluate the perioperative morbidity of PC-RPLND in two intermediate volume centers and to identify predictors of high morbidity. Methods Retrospective analysis of 124 patients treated with open PC-RPLND at two tertiary referral centers between 2001 and 2018. Perioperative morbidity was determined by analyzing additional surgical procedures, intra-operative blood loss, and postoperative complications. Results An additional procedure was necessary for 33 patients (26.6%). The risk was higher in patients with IGCCCG intermediate/poor prognosis (OR 3.56; 95% CI 1.33–9.52) and residual tumor size > 5 cm (OR 3.53; 95% CI 1.39–8.93). Blood loss was higher in patients with IGCCCG intermediate/poor prognosis (β = 0.177; p = 0.029), large residual tumor (β = 0.570; p < 0.001), an additional intervention (β = 0.342; p < 0.001) and teratoma on retroperitoneal histology (β = − 0.19; p = 0.014). Thirty-one patients had a postoperative complication Clavien-Dindo Grade ≥ 2 (25.0%). Complication risk was highest in patients undergoing an additional intervention (OR 3.46; 95% CI 1.03–11.60; p = 0.044). Conclusions The rate of additional interventions in our series is comparable to what has been reported in high-volume centers. IGCCCG intermediate/poor prognosis patients with high-volume disease and patients undergoing an additional surgical procedure can be classified as high-risk patients.

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

Abstract: In this relatively small series due to small population and low disease incidence, we have shown acceptable peri-operative course, morbidity and oncological outcomes with PC-RPLND compared to major international centres.

Cited by 11 publications

References 24 publications

Contemporary retroperitoneal lymph node dissection (RPLND) for testis cancer in the UK – a national study

Contemporary retroperitoneal lymph node dissection (RPLND) for testis cancer in the UK – a national study

Clinicopathologic and Oncological Outcomes in Korean Men With Advanced Metastatic Testicular Cancer Undergoing Postchemotherapeutic Retroperitoneal Lymph Node Dissection

Additional surgical procedures and perioperative morbidity in post-chemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer in two intermediate volume hospitals

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