R G Casey1, M Aktar, P Hegarty, M Butler, J A Thornhill. 1. Department of Urology, The Adelaide and Meath Hospital, incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland. rowcasey@rcsi.ie
Abstract
BACKGROUND: Retro-peritoneal lymph node dissection (RPLND) following chemotherapy is critical in advanced germ cell tumours with residual retro-peritoneal masses. Post-chemotherapy RPLND is more extensive, may require adjacent organ resection and has higher morbidity. The study aim was to analyse patient demographics, clinical stage, surgical procedures and cure rates following RPLND. METHODS: An RPLND database (1994-2005) was analysed prospectively for demographics, pre/post-RPLND staging, chemotherapy regimen, cure, follow-up and early/late morbidity and mortality. RESULTS: 73 patients were identified (range 17-49 median 25.7). The mean hospital stay was 14.3 days (range 6-50). Clinical stage at presentation was; IV (16), III (19), II (27), I (11) and prior to RPLND was IV (12), III (6), II (55), I (0). Eleven patients with stage I disease progressed prior to RPLND. Seventy-one patients received cisplatin-based chemotherapy with partial response (49), minimal response (14), no response (7), disease progression (3) and 13 patients required salvage chemotherapy. RPLND was bilateral (26), unilateral (36) and suprahilar (11) with nerve sparing in 10. Other major procedures included nephrectomy (22), aortic graft (1), ureterectomy (1) and caval dissection (1). RPLND histology was mature teratoma (MT) (37), fibrosis/necrosis (26), NSGCT (6), seminoma (1), mixed NSGCT/teratoma (1), sarcoma (1) and mixed seminoma/teratoma (1). Early (n = 26) and late (n = 13) morbidity was significant but expected. There was no mortality. Ninety-five per cent had complete remission following RPLND (mean follow-up 30 months). One patient is deceased following relapse. CONCLUSIONS: The decision to perform post-chemotherapy RPLND depends on the possibility of viable tumour or teratoma and surgical morbidity. Appropriate case selection and timely intervention in an experienced centre permits optimum outcome.
BACKGROUND: Retro-peritoneal lymph node dissection (RPLND) following chemotherapy is critical in advanced germ cell tumours with residual retro-peritoneal masses. Post-chemotherapy RPLND is more extensive, may require adjacent organ resection and has higher morbidity. The study aim was to analyse patient demographics, clinical stage, surgical procedures and cure rates following RPLND. METHODS: An RPLND database (1994-2005) was analysed prospectively for demographics, pre/post-RPLND staging, chemotherapy regimen, cure, follow-up and early/late morbidity and mortality. RESULTS: 73 patients were identified (range 17-49 median 25.7). The mean hospital stay was 14.3 days (range 6-50). Clinical stage at presentation was; IV (16), III (19), II (27), I (11) and prior to RPLND was IV (12), III (6), II (55), I (0). Eleven patients with stage I disease progressed prior to RPLND. Seventy-one patients received cisplatin-based chemotherapy with partial response (49), minimal response (14), no response (7), disease progression (3) and 13 patients required salvage chemotherapy. RPLND was bilateral (26), unilateral (36) and suprahilar (11) with nerve sparing in 10. Other major procedures included nephrectomy (22), aortic graft (1), ureterectomy (1) and caval dissection (1). RPLND histology was mature teratoma (MT) (37), fibrosis/necrosis (26), NSGCT (6), seminoma (1), mixed NSGCT/teratoma (1), sarcoma (1) and mixed seminoma/teratoma (1). Early (n = 26) and late (n = 13) morbidity was significant but expected. There was no mortality. Ninety-five per cent had complete remission following RPLND (mean follow-up 30 months). One patient is deceased following relapse. CONCLUSIONS: The decision to perform post-chemotherapy RPLND depends on the possibility of viable tumour or teratoma and surgical morbidity. Appropriate case selection and timely intervention in an experienced centre permits optimum outcome.