Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours

Abstract

Introduction/background: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease.

Materials and Methods: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated.

Results: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation.

Conclusions: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

Zusammenfassung

Einleitung/Hintergrund: Obwohl ein vollständiges bilaterales retroperitoneale Lymphknotendissektion (RPLND) als Behandlungsstandard für das Management retroperitonealer Restmassen nach Chemotherapie bei nichtseminomatösen Keimzelltumoren (NSGCT) gilt, wurden in den letzten 10 Jahren modifizierte Templates immer beliebter. In dieser Studie wollten wir die onkologischen und perioperativen Ergebnisse von 17 konsekutiven NSGCT-Patienten präsentieren, die sich einer modifizierten unilateralen RPLND wegen retroperitonealer Resterkrankung nach Chemotherapie (NC) unterzogen.

Material und Methoden: Wir werteten retrospektiv die Krankenakten von 17 konsekutiven NSGCT-Patienten aus, die sich zwischen 2017 und 2020 in unserem Universitätsklinikum einer modifizierten unilateralen NC-RPLND unterzogen hatten. Alle Patienten haben normale Serumtumormarker mit Resterkrankung im Retroperitoneum. Chirurgische Merkmale wie Größe der retroperitonealen Restmasse, Resttumorpathologie, entfernte Lymphknoten, positiver Prozentsatz entfernter Lymphknoten, begleitende Operationen, Komplikationen, mittlere Operationsdauer und Krankenhausaufenthalt sowie Langzeitergebnisse einschließlich Überleben und antegrade Ejakulation wurden ausgewertet.

Ergebnisse: Die linke Seite wurde bei 11 Patienten und die rechte Seite bei 6 Patienten operiert. Der mediane Rest Lymphknoten Durchmesser betrug 41mm. Die mediane Krankenhausaufenthalt Zeit betrug 3,5 Tage. Die mediane Nachbeobachtungszeit betrug 10,5 Monate. Nekrose/Fibrose wurde bei 6 Patienten und Teratome bei 11 Patienten beobachtet. Es wurde kein lebensfähiger Tumor beobachtet. Im Nachbeobachtungszeitraum starben keine Patienten. Keiner der Patienten erlitt während der Nachuntersuchung einen Rückfall. 10 der 17 Patienten hatten eine antegrade Ejakulation.

Schlussfolgerungen: Modifiziertes unilaterales NC-RPLND führt zu sehr guten onkologischen Ergebnissen mit verringerter perioperativer Morbidität sowie besseren antegraden Ejakulationsraten. Die retroperitoneale Erkrankung mit geringem Volumen scheint die am besten geeignete Gruppe für dieses Verfahren zu sein.

Keywords

post-chemotherapy - retroperitoneal lymph node dissection - modified template - germ cell tumor - nonseminomatous

Schlüsselwörter

nach der Chemotherapie - retroperitoneale Lymphknotendissektion - modifizierte Vorlage - Keimzelltumor - nichtseminomatös

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