Retroperitoneal Lymph Node Dissection in Patients With High Risk Testicular Cancer

Williams, Stephen B.; McDermott, David W.; Winston, Dock; Bahnson, Eamonn; Berry, Alexander; Steele, Graeme S.; Richie, Jerome P.

doi:10.1016/j.juro.2009.01.026

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…The rational to perform a lymph node dissection in this group of patients is the fact that a significant number of patients will harbor viable teratoma or cancer[2,15]. Although some authors suggest the possibility of performing less extensive templates for selected residual masses after chemotherapy[19], this approach has not been accepted as standard of care and we could not demonstrate a reliable pattern of dissemination to allow safe modified dissections in this setting.…”

Section: Discussionmentioning

confidence: 99%

“…In tertiary centers the overall complications appear comparable to dissections in the primary setting, but there is a tendency of more severe complications in post-chemotherapy patients. Indeed, there is a significantly longer operative time, blood loss, and transfusion rate with PC-RPLND[14,15]. Most common reported complications are ileus and lymph leaks.…”

Section: Discussionmentioning

confidence: 99%

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Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

et al. 2010

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BackgroundRetroperitoneal lymph node dissection has been advocated for the management of post-chemotherapy (PC-RPLND) residual masses of non-seminomatous germ cell tumors of the testis (NSGCT). There remains some debate as to the clinical benefit and associated morbidity. Our objective was to report our experience with PC-RPLND in NSGCT.MethodsWe have reviewed the clinical, pathologic and surgical parameters associated with PC-RPLND in a single institution. Between 1994 and 2008, three surgeons operated 73 patients with residual masses after cisplatin-based chemotherapy for a metastatic testicular cancer. Patients needed to have normal postchemotherapy serum tumor markers, no prior surgical attempts to resect retroperitoneal masses and resectable retroperitoneal tumor mass at surgery to be included in this analysisResultsMean age was 30.4 years old. Fifty-three percent had mixed germ cell tumors. The mean size of retroperitoneal metastasis was 6.3 and 4.0 cm, before and post-chemotherapy, respectively. In 56% of patients, the surgeon was able to perform a nerve sparing procedure. The overall complication rate was 27.4% and no patient died due to surgical complications. The pathologic review showed presence of fibrosis/necrosis, teratoma and viable tumor (non-teratoma) in 27 (37.0%), 30 (41.1%) and 16 (21.9%) patients, respectively. The subgroups presenting fibrosis and large tumors were more likely to have a surgical complication and had less nerve sparing procedures.ConclusionPC-RPLND is a relatively safe procedure. The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

et al. 2010

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“…No consensus exist regarding which strategy should be preferred in China. [8][9][10][11] The current challenge in managing CSI NSGCT is to achieve a cure with minimal acute or long-term toxicity related to treatment. The inherent risks of treatment are associated with radiation exposure through repeated computed tomography scans, the added morbidity of chemotherapy-induced cardiopulmonary toxicities and secondary malignancies.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes in patients with stage I non-seminomatous germ cell cancer

Lv¹,

Wu²,

Dong³

et al. 2013

Asian J Androl

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This study assesses the long-term outcomes in Han Chinese patients with clinical stage I non-seminomatous germ cell testicular cancer (CSI NSGCT) treated with surveillance, retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy. We retrospectively evaluated 89 patients with a mean age of 26.5 years. After orchiectomy, 37 patients were treated with surveillance, 34 underwent RPLND and 18 were managed with chemotherapy. The overall survival rate, the recurrence-free survival rate and the risk factors were evaluated. The median follow-up length was 92 months (range: 6-149 months). Thirteen of the 89 patients (14.6%) had relapses, and one died by the evaluation date. The overall survival rate was 98.9%. The cumulative 4-year recurrence-free rates were 80.2%, 92.0% and 100% for the surveillance, RPLND and chemotherapy groups, respectively. The disease-free period tended to be briefer in patients with a history of cryptorchidism and those with stage Is. Therefore, surveillance, RPLND and adjuvant chemotherapy might be reliable strategies in compliant patients with CSI NSGCT. Surveillance should be recommended for patients with the lowest recurrence rate, especially those without lymphovascular invasion. This study might aid the establishment of a standard therapy for CSI NSGCT in China.

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“…2 The risk of relapse can be even higher in men with high-risk features, such as lymphovascular invasion or a high percentage of embryonal carcinoma, at the time of orchiectomy. [3][4][5] Given the significant chance of relapse and rigorous surveillance protocols, many men choose either surgery or chemotherapy as upfront treatment after orchiectomy. Both retroperitoneal lymph node dissection (RPLND) and chemotherapy have proven to be an effective means of controlling the retroperitoneum and lead to high cure rates.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Retroperitoneal Lymph Node Dissection with Therapeutic Intent in Men with Clinical Stage I Nonseminomatous Germ Cell Tumors

Guzzo¹,

Gonzalgo²,

Allaf³

2010

Journal of Endourology

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Retroperitoneal Lymph Node Dissection in Patients With High Risk Testicular Cancer

Cited by 19 publications

References 18 publications

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

Clinical outcomes in patients with stage I non-seminomatous germ cell cancer

Laparoscopic Retroperitoneal Lymph Node Dissection with Therapeutic Intent in Men with Clinical Stage I Nonseminomatous Germ Cell Tumors

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