Postchemotherapy retroperitoneal residual mass resection for germ cell testicular tumors: a single-center experience

Abstract

Objective: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an important role in the management of advanced germ cell testicular tumors. Bilateral template lymph node dissection is considered a standard treatment in postchemotherapy residual masses; however, modified unilateral templates have gained acceptance in patients with unilateral residual disease. In this study, we aimed to demonstrate the perioperative and oncological outcomes of the patients with advanced testicular cancer who underwent unilateral modified template PC-RPLND in our center. Methods: This is a retrospective study in which patients who underwent PC-RPLND in a referred center between 2004 and 2021 were investigated. All patients had three or four cycles of chemotherapy and retroperitoneal residual masses. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Results: A total of 57 patients underwent PC-RPLND. The mean age was 32.7±8.1 years (19-50). According to the disease stage at presentation, there were 39 patients with stage 2 and 18 patients with stage 3. The average tumor size after chemotherapy was 57.6±2.7 mm (25-117). The overall complication rate was 35% (20/57 patients). No grade 4 and 5 complications were observed. Pathologic review demonstrated the presence of teratoma in 28 (49.1%) patients, fibrosis and/or necrosis in 15 (26.3%) patients, and viable germ cell tumor in 14 (24.5%) patients. The mean follow-up was 69.4 months (8-201). During follow-up after surgery, 14 (24.5%) deaths occurred due to advanced disease. Conclusion: PC-RPLND is a major component of the management of advanced testicular germ cell cancer. Our study demonstrated that modified unilateral template is an effective and safe procedure in the postchemotherapy setting for selected patients.

Características de pacientes con tumor germinal testicular tipo seminoma y masa retroperitoneal posquimioterapia

“…Aproximadamente el 60-80% de los pacientes TGTS estadios II y III tendrán masa residual posterior al tratamiento con QT 6 . El tratamiento de estos pacientes es controversial, y a la vez un tema de interés público, debido al aumento de su incidencia en varios países y los efectos adversos relacionados con sus tratamientos [7][8][9] .…”

The role of robotic retroperitoneal lymph node dissection in testicular cancer: a systematic review and meta-analysis

“…RPLND plays an important role in the treatment of patients with testicular cancer who are undergoing aggressive chemotherapy and monitoring 28 . In addition, it can also be used for the treatment of residual masses after chemotherapy, and bilateral template lymph node dissection is considered the standard treatment for residual masses after chemotherapy 29 . RPLND has both staging and therapeutic significance 30 .…”

Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives

“…Bilateral PC-RPLND showed an 80% OS at 38-month follow-up [ 91 ] and a 5-year disease-specific survival (DSS) rate of 74% [ 106 ] and 98% [ 107 ], respectively. Unilateral modified template PC-RPLND showed a 75.5% OS at 47-month follow-up [ 108 ], 99% OS at 10-year follow-up, 93% RFS after 5 years, and 92% RFS after 10 years [ 102 ].…”