Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumo
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor Murilo A Luz1, Ahmed F Kotb1, Saad Aldousari1, Fadi Brimo2, Simon Tanguay1, Wassim Kassouf1, Armen G Aprikian1*
Abstract Background: Retroperitoneal lymph node dissection has been advocated for the management of postchemotherapy (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.
Background In accordance with the last report of The Public Health Agency of Canada (PHAC), the incidence of testicular cancer in Canada is rising and is the most common cancer in young men. The two main histologic subgroups occur with similar frequencies: 54% are seminoma and 41% non-seminoma germ cell tumors; 5% are other types[1]. Testicular cancer has become the model for a curable neoplasm. In treatment of nonseminomatous germ cell * Correspondence: [email protected] 1 Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada Full list of author information is available at the end of the article
testicular tumors (NSGCTT), there have been great improvements in the last 25 years. Cure rates for clinical stage I and low-volume stage II testis tumor patients approach 100%; selecting the best initial modality of treatment and integration of surgery and chemotherapy is critical to optimizing cure and minimizing morbidity [2,3]. Furthermore, stage IIb and III metastatic NSGCT have very high cure rates owing to improvements in multi-
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