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VENA CAVAL RESECTION FOR BULKY METASTATIC GERM CELL TUMORS: AN 18-YEAR EXPERIENCE

1997; Lippincott Williams & Wilkins; Volume: 158; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(01)64137-5

1527-3792

Aaron Spitz, Timothy G. Wilson, Mark H. Kawachi, Thomas E. Ahlering, Donald G. Skinner,

Urologic and reproductive health conditions

No AccessJournal of UrologyClinical Urology: Original Articles1 Nov 1997VENA CAVAL RESECTION FOR BULKY METASTATIC GERM CELL TUMORS: AN 18-YEAR EXPERIENCE Aaron Spitz, Timothy G. Wilson, Mark H. Kawachi, Thomas E. Ahlering, and Donald G. Skinner Aaron SpitzAaron Spitz , Timothy G. WilsonTimothy G. Wilson , Mark H. KawachiMark H. Kawachi , Thomas E. AhleringThomas E. Ahlering , and Donald G. SkinnerDonald G. Skinner View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64137-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The operative management and followup of vena caval resection for bulky metastatic germ cell tumors have been previously described in 3 series. In 1989 Ahlering and Skinner described their experience with 12 patients. We now update this experience with the most recent followup on 19 patients. Materials and Methods: From April 1978 to May 1995, 19 men underwent retroperitoneal lymph node dissection for stage B3 (N3) or C (N3, M+) germ cell tumor after induction chemotherapy. In all cases the inferior vena cava was resected because of extensive thrombosis or direct involvement of the vessel wall by a tumor. The inferior vena cava was resected from just below the renal veins to beyond the level of disease involvement. Complete resection of retroperitoneal disease was accomplished in all patients. Morbidity and mortality were examined. Results: The mean hospital stay was 10 days (range 7 to 13) for uncomplicated recoveries (9 patients) versus 19 days (range 6 to 32) for complicated recoveries (10 patients). Followup ranged from 1 month to 16 years. Complications included prolonged ileus, small bowel obstruction, fascial dehiscence and pneumonia with pleural effusion. Chronic edema persisted in 3 of 11 patients with followup of greater than 6 months. Of the 6 patients who died of disease recurrence 4 did not have normalization of tumor markers before surgery, and all 4 had persistence of cancer in the resected specimen. Seven patients are without disease at followup of 24 months to 16 years. All survivors had normalized tumor markers before surgery. Only 1 patient (5%) had retroperitoneal recurrence. Conclusions: En bloc vena caval resection for tumor involvement or extensive thrombosis can be associated with short and long-term morbidity, is feasible, and may contribute to a prolonged tumor-free interval and a chance for cure. References 1 : Phase II trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation in first line therapy for patients with poor-risk germ cell tumors. J. Natl. Cancer Inst.1993; 85: 1828. Google Scholar 2 : En bloc resection of inferior vena cava in cytoreductive surgery for bulky retroperitoneal metastatic testicular cancer. Urology1980; 16: 51. 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Google Scholar From the Department of Urology, University of Southern California, Los Angeles, the City of Hope National Medical Center, Duarte, and the University of California at Irvine, Irvine, California.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byJohnston P, Beck S, Cheng L, Masterson T, Bihrle R, Kesler K and Foster R (2018) Incidence, Histology and Management of Intraluminal Thrombus at Post-Chemotherapy Retroperitoneal Lymph Node DissectionJournal of Urology, VOL. 190, NO. 3, (874-877), Online publication date: 1-Sep-2013.Caso J, Seigne J, Back M, Spiess P, Pow-Sang J and Sexton W (2018) Circumferential Resection of the Inferior Vena Cava for Primary and Recurrent Malignant TumorsJournal of Urology, VOL. 182, NO. 3, (887-893), Online publication date: 1-Sep-2009.Duty B and Daneshmand S (2018) Venous Resection in Urological SurgeryJournal of Urology, VOL. 180, NO. 6, (2338-2342), Online publication date: 1-Dec-2008. Volume 158Issue 5November 1997Page: 1813-1818 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Aaron Spitz More articles by this author Timothy G. Wilson More articles by this author Mark H. Kawachi More articles by this author Thomas E. Ahlering More articles by this author Donald G. Skinner More articles by this author Expand All Advertisement PDF downloadLoading ...