Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor?

Stephen D.W. Beck, Richard S. Foster, Richard Bihrle, John P. Donohue, Lawrence H. Einhorn

Research output: Contribution to journalReview articlepeer-review

77 Scopus citations

Abstract

BACKGROUND. Traditionally, postchemotherapy (PC) surgery for metastatic non-seminomatous germ cell tumor (NSGCT) has used a full bilateral retroperitoneal lymph node dissection (RPLND) from the crus of the diaphragm to the bifurcation of the common iliac arteries, from ureter to ureter. With the primary landing zone well defined in low-volume retroperitoneal disease, the authors performed modified dissections in the PC setting in a select population; and, herein, they report disease outcome. METHODS. From 1991 to 2004, a retrospective review of the testicular cancer database at the authors' institution was performed to identify patients with NSGCT, normal serum tumor markers after cisplatin-based chemotherapy, and residual retroperitoneal tumor who underwent modified PC-RPLND. All patients had metastatic disease at initial presentation that was limited to the primary landing zone (left or right). RESULTS. One hundred patients were identified, including 43 who underwent a right modified template, 18 patients who underwent a left full modified template, and 39 patients who underwent a left modified template. Pathology revealed cancer in 2% of patients, teratoma in 62% of patients, and necrosis in 36% of patients. The 2- and 5-year disease-free survival rate was 95%, and the median follow-up was 31.9 months (range, 1-152 months). Four patients developed recurrent disease with a median time to recurrence of 8.25 months (range, 6-11 months). All recurrences were outside the boundaries of a full bilateral RPLND. CONCLUSIONS. Selected patients at PC surgery can be managed with modified PC-RPLND.

Original languageEnglish (US)
Pages (from-to)1235-1240
Number of pages6
JournalCancer
Volume110
Issue number6
DOIs
StatePublished - Sep 15 2007

Keywords

  • Modified
  • Retroperitoneal lymph node dissection
  • Teratoma
  • Testicular cancer

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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