Desperation Retroperitoneal Lymph Node Dissection for Metastatic Germ Cell Tumors
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Despite favorable long-term survival, the multimodal treatment of nonseminomatous germ cell tumor (NSGCT) is constantly evolving and incorporating new paradigms. This chapter aims to present available evidence regarding the management of the violated scrotum, the role of laparoscopic retroperitoneal lymph node dissection (RPLND), the management of the normal retroperitoneum after platinum chemotherapy, the management of stage IS NSGCT, and the management of the high risk stage I NSGCT patient
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You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2012920 NERVE-SPARING RETROPERITONEAL LYMPH NODE DISSECTION IN METASTATIC TESTICULAR CANCER Emmanuel Mitsinikos, Nick Tadros, and Siamak Daneshmand Emmanuel MitsinikosEmmanuel Mitsinikos Los Angeles, CA More articles by this author , Nick TadrosNick Tadros Portland, OR More articles by this author , and Siamak DaneshmandSiamak Daneshmand Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preservation of fertility is of significant concern in patients with testicular cancer. Nerve-sparing RPLND (NS-RPLND) reduces the incidence of retrograde ejaculation but prior chemotherapy and large masses can increase the risk of nerve damage and impaired emission. We report our experience with NS-RPLND in patients metastatic TC. METHODS From 2004-2010, 100 patients underwent RPLND (90 post-chemotherapy (PC), 10 primary) for metastatic testis cancer by a single surgeon (SD). Of these, 44 patients with metastatic TC underwent primary (4 Stage IIA, 1 Stage IIB) or PC (39) NS-RPLND. Dissections were bilateral with contralateral dissection limited inferiorly by the IMA. Post-ganglionic sympathetic nerves were spared at least unilaterally. Clinical characteristics, laterality of nerve sparing, tumor size and microscopic evaluation of the RP mass were obtained from patient charts. Ejaculatory status was acquired from follow-up clinic notes or telephone contact. Thirty-seven patients underwent NS PC-RPLND after induction chemotherapy and 2 underwent NS PC-RPLND following salvage chemotherapy. RESULTS Follow-up data was available for 38 patients (86%). Mean follow-up was 10 months. Median size of the RP mass was 5.1cm in largest dimension. Thirty-four of the 38 patients (89%) who underwent NS-RPLND retained normal ejaculation, including the two who underwent salvage chemotherapy. There was no statistically significant difference in rates of antegrade ejaculation with preservation of right only, left only, or bilateral nerve fibers (p=0.58) Three patients had RP recurrence, and two had extra-abdominal recurrence, at a mean of 12 months post-operatively. The patients with RP recurrence were high risk (2 PC-RPLNDs with viable seminoma in resected tissue; one stage IIB primary RPLND for non-seminoma TC in a patient with end stage renal failure unable to undergo primary chemotherapy). The two extra-abdominal recurrences were in patients with a non germ cell tumor (rhabdomyosarcoma) and a large (12cm) teratoma who developed lung metastases. CONCLUSIONS NS-RPLND in the metastatic and post-chemotherapy setting is a technically demanding procedure however can preserve ejaculatory function in the majority of patients, thus improving quality of life. Preservation of at least one post-ganglionic sympathetic nerve fiber on either side appears to prevent retrograde ejaculation in most cases. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e375 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Emmanuel Mitsinikos Los Angeles, CA More articles by this author Nick Tadros Portland, OR More articles by this author Siamak Daneshmand Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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You have accessJournal of Urology1 Apr 2009NUMBER OF LYMPH NODES RESECTED AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION AND CANCER-SPECIFIC SURVIVAL FOR NON-SEMINOMATOUS GERM CELL TUMOR OF THE TESTICLE Michael C Large, Dezheng Huo, and Scott E Eggener Michael C LargeMichael C Large More articles by this author , Dezheng HuoDezheng Huo More articles by this author , and Scott E EggenerScott E Eggener More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)60927-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "NUMBER OF LYMPH NODES RESECTED AT PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION AND CANCER-SPECIFIC SURVIVAL FOR NON-SEMINOMATOUS GERM CELL TUMOR OF THE TESTICLE." The Journal of Urology, 181(4S), p. 326 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 326 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Michael C Large More articles by this author Dezheng Huo More articles by this author Scott E Eggener More articles by this author Expand All Advertisement PDF downloadLoading ...
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You have accessJournal of UrologyPenis/Testis: Benign & Malignant Disease II1 Apr 2014MP10-12 LYMPH NODE COUNTS FROM PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION FOR NONSEMINOMATOUS GERM CELL TUMORS OF TESTIS Madhur Nayan, Michael A.S. Jewett, Lynn Anson-Cartwright, Joan Sweet, Philippe Bedard, Malcolm Moore, Peter Chung, Padraig Warde, and Robert J. Hamilton Madhur NayanMadhur Nayan More articles by this author , Michael A.S. JewettMichael A.S. Jewett More articles by this author , Lynn Anson-CartwrightLynn Anson-Cartwright More articles by this author , Joan SweetJoan Sweet More articles by this author , Philippe BedardPhilippe Bedard More articles by this author , Malcolm MooreMalcolm Moore More articles by this author , Peter ChungPeter Chung More articles by this author , Padraig WardePadraig Warde More articles by this author , and Robert J. HamiltonRobert J. Hamilton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.468AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have demonstrated the diagnostic and prognostic value of total number of lymph nodes removed at surgery for various urological and non-urological malignancies. However, there have only been a limited number of studies regarding number of lymph nodes removed during retroperitoneal lymph node dissection (RPLND) for germ cell tumor of the testis. METHODS 157 patients underwent primary open RPLND performed by a single experienced surgeon for clinical stages I & II nonseminomatous germ cell tumor (NSGCT). Node count was available for 111 (71%) patients. Factors associated with total node count and nodes with viable cancer were assessed using linear regression. The association between node count and time to relapse were assessed using multivariate Cox proportional hazards models including controlling for adjuvant chemotherapy. RESULTS Median total lymph node count was 28 (IQR 19-38). Age, side of cancer, BMI, clinical stage, time from orchiectomy to RPLND, pathologist and year of RPLND were not associated with total lymph node count. Viable tumor was found in 70 patients (63%). Total node yield did not predict presence of viable cancer. After RPLND, 17 (16%) received adjuvant chemotherapy. With a median follow-up of 57 months, 18 (17%) of the remaining patients relapsed. Total node count was inversely associated with time to relapse on uni- and multivariate analyses. As an example, patients with node yield above the median for the cohort had an 81% reduction in the risk of relapse (HR 0.19, 95% CI 0.04-0.97, p=0.04). CONCLUSIONS Our data suggest that while there appears to be no clinical or pathological variables associated with node yield from RPLND, there appears to be a relationship between total node yield and risk of relapse. Our findings provide further evidence that meticulous RPLND is important and that pathologists need to perform a detailed assessment of the surgical specimens. However, factors contributing to final node count are multifactorial and counts have not been validated in surgical quality comparisons between institutions. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e118-e119 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Madhur Nayan More articles by this author Michael A.S. Jewett More articles by this author Lynn Anson-Cartwright More articles by this author Joan Sweet More articles by this author Philippe Bedard More articles by this author Malcolm Moore More articles by this author Peter Chung More articles by this author Padraig Warde More articles by this author Robert J. Hamilton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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You have accessJournal of UrologyPodium, Monday, May 10, 2004, 10:00 am - 12:00 pm1 Apr 2004929: Incidence and Clinical Characteristics of Paraaortic Lymph Node Metastases Diagnosed at Primary Retroperitoneal Lymph Node Dissection for Patients with Germ Cell Tumors of the Right Testis Theresa M. Koppie, Jason Stasi, and Joel Sheinfeld Theresa M. KoppieTheresa M. Koppie More articles by this author , Jason StasiJason Stasi More articles by this author , and Joel SheinfeldJoel Sheinfeld More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38178-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "929: Incidence and Clinical Characteristics of Paraaortic Lymph Node Metastases Diagnosed at Primary Retroperitoneal Lymph Node Dissection for Patients with Germ Cell Tumors of the Right Testis." The Journal of Urology, 171(4S), pp. 246–247 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 246-247 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Theresa M. Koppie More articles by this author Jason Stasi More articles by this author Joel Sheinfeld More articles by this author Expand All Advertisement Loading ...
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Abstract In the testicular cancer post‐treatment setting a rapidly growing retroperitoneal mass leads to a differential diagnosis including recurrent germ cell tumor, residual mature teratoma, or sarcomatoid degeneration. We report the case of a 27‐year‐old man with a large abdominal mass occurring in the setting of a mixed germ cell tumor after radical orchiectomy with primary chemotherapy followed by retroperitoneal lymph node dissection. Surgical excision of this mass followed by pathological review revealed an intra‐abdominal desmoid tumor. Fluorescence in situ hybridization (FISH) for isochromosome 12p failed to demonstrate a germ cell tumor origin. This is the fourth such case of an intra‐abdominal desmoid tumor after retroperitoneal lymph node dissection for testicular cancer in the urologic literature. This case highlights the need for careful consideration of a desmoid tumor when a rapidly growing spindle cell tumor is encountered in a post‐treatment testis cancer patient.
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