Retroperitoneal lymph-node dissection (RPLND) as upfront management in stage II germ-cell tumours: Evaluation of safety and efficacy.
Tumori
; 109(4): 379-386, 2023 Aug.
Article
en En
| MEDLINE
| ID: mdl-35915559
ABSTRACT
INTRODUCTION:
Patients with stage II germ-cell tumours (GCT) usually undergo radiotherapy (seminoma only) or chemotherapy. Both strategies display a recognised risk of long-term side effects. We evaluated retroperitoneal lymph node dissection (RPLND) as exclusive treatment in stage II GCT.METHODS:
Between 2008 and 2019 included, 66 selected stage II GCT patients underwent primary open (O-) or laparoscopic (L-)RPLND. Type of procedure and extent of dissection, operative time, node rescue, hospital stay, complications (according to Clavien-Dindo), administration of chemotherapy, relapse and site of relapse were evaluated.RESULTS:
Five patients had pure testicular seminoma. Nineteen (28.8%) had raised markers prior to RPLND; 48 (72.7%), 16 (24.2%) and two (3.0%) were stage IIA, IIB and IIC, respectively. O-RPLND and unilateral L-RPLND were 36 and 30 respectively. Six stage II A patients (12.5%) had negative nodes. Four patients underwent immediate adjuvant chemotherapy. One patient was lost at follow-up. After a median follow-up of 29 months, 48 (77.4%) of the 62 patients undergoing RPLND alone remained recurrence-free; one patient had an in-field recurrence following a bilateral dissection. According to procedure, number of rescued nodes (O-RPLND 25. IQR 21-31; L-RPLND 20, IQR 15-26; p 0.001), hospital stay (L-RPLND 3 days, IQR 3-4; O-RPLND 6 days, IQR 5-8; p .001) and grade ≥2 complications (L-RPLND 7%, O-RPLND 22%; p 0.1) were the only significant differences.CONCLUSION:
Primary RPLND is safe in stage II GCT, including seminoma, and may warrant a cure rate greater than 70%. When feasible, L-RPLND may be as effective as O-RPLND with better tolerability.Palabras clave
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Neoplasias Testiculares
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Laparoscopía
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Seminoma
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Neoplasias de Células Germinales y Embrionarias
Límite:
Humans
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Male
Idioma:
En
Revista:
Tumori
Año:
2023
Tipo del documento:
Article
País de afiliación:
Italia