Alessandro Nini1, Marcus Konieczny2, Christian Winter3, Achim Lusch3, Rüdiger Krauspe2, Peter Albers3. 1. Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: alenini87@gmail.com. 2. Department of Orthopedic Surgery, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany. 3. Department of Urology, University Hospital Düsseldorf, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany.
Abstract
OBJECTIVE: To report perioperative and oncological outcomes of patients with nodal and bone involvement treated with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and simultaneous bone resection (BR). PATIENTS AND METHODS: Between 2008 and 2016, 14 consecutive unselected TC patients with nodal and bone involvement underwent PC-RPLND and BR. Surgery was performed together with orthopedic surgeons. Standard PC-RPLNDs were performed in 4 patients. Bilateral template PC-RPLND was carried out in 10 patients. Complete BR combined with spacer implantation (XPand Cage) and posterior stabilization was performed in 6 patients. Instead, 8 patients were submitted to partial BR. Perioperative outcomes consisted of operative time, blood loss, length of hospital stay, and complications. Disease recurrence and mortality were registered. RESULTS: Mean operative time, blood loss, and length of hospital stay were 295 minutes, 3.7, l, and 13 days. Additional oncological surgery was performed on 5 patients. Overall, 9 patients had adjunctive surgeries or intraoperative complications. Pathologic report consisted of teratoma in 6, cancer in 5, necrosis in 3 patients. Overall, 2, 5, and 1 patients had Clavien I, II, and IIIA complications, respectively. No perioperative mortality was recorded. Disease recurrence and death occurred in 8 and 7 patients. CONCLUSIONS: PC-RPLND and BR is a safe, feasible, and challenging procedure. Availability of an orthopedic surgeon and stabilization of the spine are mandatory. Complete BR has therapeutic impact on patients harboring teratoma, partial BR seems to be beneficial in patients with necrosis. Patients with vital tumor will relapse irrespectively of the BR approach.
OBJECTIVE: To report perioperative and oncological outcomes of patients with nodal and bone involvement treated with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) and simultaneous bone resection (BR). PATIENTS AND METHODS: Between 2008 and 2016, 14 consecutive unselected TC patients with nodal and bone involvement underwent PC-RPLND and BR. Surgery was performed together with orthopedic surgeons. Standard PC-RPLNDs were performed in 4 patients. Bilateral template PC-RPLND was carried out in 10 patients. Complete BR combined with spacer implantation (XPand Cage) and posterior stabilization was performed in 6 patients. Instead, 8 patients were submitted to partial BR. Perioperative outcomes consisted of operative time, blood loss, length of hospital stay, and complications. Disease recurrence and mortality were registered. RESULTS: Mean operative time, blood loss, and length of hospital stay were 295 minutes, 3.7, l, and 13 days. Additional oncological surgery was performed on 5 patients. Overall, 9 patients had adjunctive surgeries or intraoperative complications. Pathologic report consisted of teratoma in 6, cancer in 5, necrosis in 3 patients. Overall, 2, 5, and 1 patients had Clavien I, II, and IIIA complications, respectively. No perioperative mortality was recorded. Disease recurrence and death occurred in 8 and 7 patients. CONCLUSIONS: PC-RPLND and BR is a safe, feasible, and challenging procedure. Availability of an orthopedic surgeon and stabilization of the spine are mandatory. Complete BR has therapeutic impact on patients harboring teratoma, partial BR seems to be beneficial in patients with necrosis. Patients with vital tumor will relapse irrespectively of the BR approach.
Authors: Bettina Baessler; Tim Nestler; Daniel Pinto Dos Santos; Pia Paffenholz; Vikram Zeuch; David Pfister; David Maintz; Axel Heidenreich Journal: Eur Radiol Date: 2019-12-11 Impact factor: 5.315