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Retroperitoneal lymph node dissection for residual masses after chemotherapy in nonseminomatous germ cell testicular tumor.

Luz MA, Kotb AF, Aldousari S, Brimo F, Tanguay S, Kassouf W, Aprikian AG - World J Surg Oncol (2010)

Bottom Line: There remains some debate as to the clinical benefit and associated morbidity.PC-RPLND is a relatively safe procedure.The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.

ABSTRACT

Background: Retroperitoneal 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.

Methods: We 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 analysis

Results: Mean 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.

Conclusion: PC-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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Related in: MedlinePlus

A/B: correlation between PC-RPLND histology and nerve-sparing procedures (A) and surgical complications (B); C: correlation between residual mass size and surgical complications; D: Five-year disease-free survival rate after PC-RPLND.
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Figure 2: A/B: correlation between PC-RPLND histology and nerve-sparing procedures (A) and surgical complications (B); C: correlation between residual mass size and surgical complications; D: Five-year disease-free survival rate after PC-RPLND.

Mentions: With respect to predictors of surgical complications, we observed a correlation between the presence of fibrosis with non-nerve sparing surgeries and surgical complications (p < 0.05) (Figure 2a/2b). In other words, in the presence of fibrosis, it was more likely to have a surgical complication or aborted attempt at nerve-sparing. Paradoxically, the patients with tumor (teratoma or carcinoma) were less likely to have a surgical complication or a greater chance at having nerve preservation. None of the variables analyzed correlated with the presence of viable cancer.


Retroperitoneal lymph node dissection for residual masses after chemotherapy in nonseminomatous germ cell testicular tumor.

Luz MA, Kotb AF, Aldousari S, Brimo F, Tanguay S, Kassouf W, Aprikian AG - World J Surg Oncol (2010)

A/B: correlation between PC-RPLND histology and nerve-sparing procedures (A) and surgical complications (B); C: correlation between residual mass size and surgical complications; D: Five-year disease-free survival rate after PC-RPLND.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2991320&req=5

Figure 2: A/B: correlation between PC-RPLND histology and nerve-sparing procedures (A) and surgical complications (B); C: correlation between residual mass size and surgical complications; D: Five-year disease-free survival rate after PC-RPLND.
Mentions: With respect to predictors of surgical complications, we observed a correlation between the presence of fibrosis with non-nerve sparing surgeries and surgical complications (p < 0.05) (Figure 2a/2b). In other words, in the presence of fibrosis, it was more likely to have a surgical complication or aborted attempt at nerve-sparing. Paradoxically, the patients with tumor (teratoma or carcinoma) were less likely to have a surgical complication or a greater chance at having nerve preservation. None of the variables analyzed correlated with the presence of viable cancer.

Bottom Line: There remains some debate as to the clinical benefit and associated morbidity.PC-RPLND is a relatively safe procedure.The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.

ABSTRACT

Background: Retroperitoneal 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.

Methods: We 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 analysis

Results: Mean 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.

Conclusion: PC-RPLND is a relatively safe procedure. The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.

Show MeSH
Related in: MedlinePlus