Retroperitoneal Lymph Node Dissection in Patients With High Risk Testicular Cancer
2009; Lippincott Williams & Wilkins; Volume: 181; Issue: 5 Linguagem: Inglês
10.1016/j.juro.2009.01.026
ISSN1527-3792
AutoresStephen B. Williams, David W. McDermott, Winston Dock, Eamonn Bahnson, Alexander Berry, Graeme S. Steele, Jerome P. Richie,
Tópico(s)Ovarian cancer diagnosis and treatment
ResumoNo AccessJournal of UrologyAdult Urology1 May 2009Retroperitoneal Lymph Node Dissection in Patients With High Risk Testicular Cancer Stephen B. Williams, David W. McDermott, Winston Dock, Eamonn Bahnson, Alexander M. Berry, Graeme S. Steele, and Jerome P. Richie Stephen B. WilliamsStephen B. Williams More articles by this author , David W. McDermottDavid W. McDermott More articles by this author , Winston DockWinston Dock More articles by this author , Eamonn BahnsonEamonn Bahnson More articles by this author , Alexander M. BerryAlexander M. Berry More articles by this author , Graeme S. SteeleGraeme S. Steele More articles by this author , and Jerome P. RichieJerome P. Richie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.01.026AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In patients with testicular cancer the percent of embryonal carcinoma and lymphovascular invasion in the primary tumor have been identified as risk factors for occult metastatic disease. We reviewed differences between primary and post-chemotherapy retroperitoneal lymph node dissection in patients at high risk. Materials and Methods: Patients who underwent retroperitoneal lymph node dissection at our institution from 1993 to 2006 were identified and the clinical charts were reviewed. A total of 247 patients with orchiectomy specimens containing greater than 30% embryonal carcinoma were identified and perioperative data were obtained. Results: Of 247 patients 133 (53%) had greater than 30% embryonal carcinoma, including 76 (57%) with combined lymphovascular invasion. Median followup was 3.49 years. Of the patients 76 (57%) and 57 (43%) underwent primary and post-chemotherapy retroperitoneal lymph node dissection, respectively, of whom most received bleomycin, etoposide and cisplatin. Positive lymph nodes were identified at surgery in 37 (49%) and 35 patients (61%) with primary and post-chemotherapy retroperitoneal lymph node dissection, respectively. Of patients with negative pathological findings at surgery surveillance computerized tomography postoperatively identified retroperitoneal masses in 2 (5%) and 3 (14%) of those who underwent a primary and a post-chemotherapy procedure, respectively. Operative data on the primary vs post-chemotherapy groups showed an estimated blood loss of 166 vs 371 cc, an operative time of 2.7 vs 3.3 hours and a hospital stay of 4.4 vs 4.7 days. There were no deaths in either group. Conclusions: Patients with greater than 30% embryonal carcinoma with or without lymphovascular invasion are at significant risk for metastatic disease and they can be successfully treated with primary retroperitoneal lymph node dissection. Recurrence rates based on computerized tomography evaluation were low and similar between the chemotherapy and nonchemotherapy treated groups. References 1 : Computed tomography-an increasing source of radiation exposure. N Engl J Med2007; 357: 2277. Google Scholar 2 : Prognostic risk factors that identify patients with clinical stage I nonseminomatous germ cell tumors at low risk and high risk for metastasis. Cancer1998; 83: 1002. Google Scholar 3 : Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma-predominant testis cancer. J Clin Oncol2000; 18: 358. 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Google Scholar Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byWilliams S, Kacker R, Winston D, Bahnson E, Steele G and Richie J (2011) Predictors of Positive Retroperitoneal Lymph Nodes in Patients With High Risk Testicular CancerJournal of Urology, VOL. 186, NO. 6, (2245-2248), Online publication date: 1-Dec-2011.Williams S, Steele G and Richie J (2009) Primary Retroperitoneal Lymph Node Dissection in Patients With Clinical Stage IS Testis CancerJournal of Urology, VOL. 182, NO. 6, (2716-2720), Online publication date: 1-Dec-2009. Volume 181 Issue 5 May 2009 Page: 2097-2102 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordstestiscarcinomaembryonallymph node excisionneoplasm invasivenessdrug therapyMetrics Author Information Stephen B. Williams More articles by this author David W. McDermott More articles by this author Winston Dock More articles by this author Eamonn Bahnson More articles by this author Alexander M. Berry More articles by this author Graeme S. Steele More articles by this author Jerome P. Richie More articles by this author Expand All Advertisement PDF downloadLoading ...
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