Post-chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ Cell Testicular Tumors.

Autor: Pickersgill NA; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO., Raval NS; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO., Kim EH; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO., Black RG; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO., Du K; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO., Figenshau RS; Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: figenshaur@wustl.edu.
Jazyk: angličtina
Zdroj: Clinical genitourinary cancer [Clin Genitourin Cancer] 2021 Jun; Vol. 19 (3), pp. 273.e1-273.e5. Date of Electronic Publication: 2020 Sep 18.
DOI: 10.1016/j.clgc.2020.09.003
Abstrakt: Introduction: Retroperitoneal lymph node dissection (RPLND) is performed to treat residual disease following chemotherapy for stage II and III testicular cancer. Significant morbidity can be associated with open RPLND. As such, laparoscopic techniques have been demonstrated to be safe and effective in select cases. Outcomes following post-chemotherapy laparoscopic RPLND for mixed malignant germ cell testicular tumors (MMGCT) are limited in the literature.
Patients and Methods: We performed a retrospective chart review for patients who underwent laparoscopic RPLND at our institution for MMGCT from May 2006 to October 2016. Patient clinical data and perioperative and oncologic outcomes were recorded.
Results: Twenty-three patients underwent post-chemotherapy laparoscopic RPLND. Thirty-five percent (8/23) underwent bilateral template dissection, whereas 65% (15/23) underwent a modified unilateral template dissection. Robotic assistance was utilized in 22% (5/23) of cases. Bilateral template was inferior to unilateral template RPLND in operative time, estimated blood loss, open conversion rate, length of hospital stay, and complication rate. The mean follow-up was 35.1 months and 43.3 months for the bilateral and unilateral template groups, respectively. The mean lymph node yield and recurrence rate were similar between the 2 cohorts. One recurrence of mature teratoma was noted 67 months after unilateral laparoscopic RPLND.
Conclusions: In select patients, laparoscopic RPLND for stage II and III MMGCT is safe and effective in the post-chemotherapy setting. Bilateral template laparoscopic RPLND was associated with inferior perioperative outcomes, but similar oncologic outcomes compared with unilateral template. Patients requiring bilateral template RPLND should be considered for an open approach.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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