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Heidenreich J, Gößmann R, Seelemeyer F, Pfister D, Paffenholz P, Heidenreich A. [Primary retroperitoneal lymph node dissection in testicular germ cell cancer in clinical stage IIA/B-renaissance of an established treatment?]. UROLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00120-024-02435-y. [PMID: 39269528 DOI: 10.1007/s00120-024-02435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The guideline-recommended treatment of choice for clinical stage IIA/B testicular germ cell tumors is chemotherapy with three cycles of PEB/four cycles of PE or, alternatively, radiation for seminomas. Despite their high curative efficacy, both options are associated with significant long-term toxicities. We evaluated the functional and oncological outcomes of primary retroperitoneal lymph node dissection (RPLND) as a therapeutic alternative. PATIENTS AND METHODS Between 2018 and 2022, 76 patients (n = 34 seminomas, n = 42 nonseminomas) underwent primary RPLND for marker-negative clinical stage IIA/B testicular germ cell cancer. All patients underwent nerve-sparing RPLND with a unilateral or bilateral template dissection and had a follow-up ≥ 3 months. None of the patients received adjuvant chemotherapy. In 24 patients, the serum concentration of miR371a-3p was evaluated preoperatively. Follow-up was performed according to EAU guidelines. RESULTS Median age and median follow-up were 30.1 (17-62) years and 29.3 (3-72) months, respectively. Mean operation time, blood loss, and duration of hospitalization were 131 (105-195) min, < 150 ml, and 4.5 (3-9) days, respectively. A Clavien-Dindo IIIa complication was experienced by 8 (10.9%) patients. Antegrade ejaculation was preserved in 90.8%. A mean number of 19 (7-68) lymph nodes were dissected. The mean number of positive lymph nodes was 1.1 (1-5), and the mean diameter of positive lymph nodes was 2.4 (0.8-4.6) cm. Eleven (14.5%) patients had stage pN0 (3/34 seminomas, 8/42 nonseminomas). In 24/27 patients (88.9%) miR371 was positive, and it was negative in 4/4 with pN0 and 3/3 (100%) with teratoma. An outfield relapse was experienced by 7 patients (9.2%), who then received salvage chemotherapy. CONCLUSION Primary RPLND for marker-negative clinical stage IIA/B germ cell tumors results in high cure rates without adjuvant chemotherapy and is associated with a low rate of complications if performed in experienced hands. Therefore, primary RPLND should be included in the management of these patients.
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Affiliation(s)
- Julian Heidenreich
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50927, Köln, Deutschland
| | - Ruben Gößmann
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50927, Köln, Deutschland
| | - Felix Seelemeyer
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50927, Köln, Deutschland
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50927, Köln, Deutschland
| | - Pia Paffenholz
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50927, Köln, Deutschland
| | - Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50927, Köln, Deutschland.
- Klink für Urologie, Medizinische Universität Wien, Wien, Österreich.
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Venkatesh S, Phillips MR, Krishnamurthy SS, Suresh K, Malik K, Ramakrishnan AS, Krishnamurthy A, Ellusamy HR, Raja A. Suprahilar and Retrocrural Domains in RPLND for NSGCT Testis-Going Beyond Where the Light Touches! Indian J Surg Oncol 2024; 15:483-492. [PMID: 39328724 PMCID: PMC11422412 DOI: 10.1007/s13193-024-02039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/18/2024] [Indexed: 09/28/2024] Open
Affiliation(s)
- Shrinivas Venkatesh
- Department of Surgical Oncology, Cancer Institute (WIA), No: 38, Sardar Patel Road, Adyar, Chennai, 600036 India
| | - Malar Raj Phillips
- Department of Surgical Oncology, Cancer Institute (WIA), No: 38, Sardar Patel Road, Adyar, Chennai, 600036 India
| | - Shalini Shree Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), No: 38, Sardar Patel Road, Adyar, Chennai, 600036 India
| | | | | | | | - Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), No: 38, Sardar Patel Road, Adyar, Chennai, 600036 India
| | - Hemanth Raj Ellusamy
- Department of Surgical Oncology, Cancer Institute (WIA), No: 38, Sardar Patel Road, Adyar, Chennai, 600036 India
| | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), No: 38, Sardar Patel Road, Adyar, Chennai, 600036 India
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Zeng J, Cary C, Masterson TA. Retroperitoneal Lymph Node Dissection: Perioperative Management and Updates on Surgical Techniques. Urol Clin North Am 2024; 51:407-419. [PMID: 38925743 DOI: 10.1016/j.ucl.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Retroperitoneal lymph node dissection (RPLND) has been an integral part of a multimodal treatment strategy in testicular cancer. Surgeons, over the last decade, have advanced the understanding of RPLND by adopting perioperative care pathways, innovative biomarkers, surgical techniques, and developing algorithms for managing complications. This review summarizes updates on various aspects including the enhanced recovery after surgery pathway, imaging techniques, surgical approaches, dissection templates, and the management of complications. We conclude that RPLND has undergone significant evolution and refinement in the modern era and will continue to hold a critical role in the care of patients with testicular cancer.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, Indiana University, Indianapolis, IN 46202, USA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN 46202, USA
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Fazekas FE, Ujfaludi Z, Biró K, Páhi ZG, Buzogány I, Sükösd F, Pankotai T, Beöthe T. Complex treatment of residual metastatic germ cell cancer: A single center experience. J Biotechnol 2024; 389:61-67. [PMID: 38692356 DOI: 10.1016/j.jbiotec.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Testicular cancer is the most common solid malignancy among men aged 15-35. Radical orchiectomy and platinum-based chemotherapy (BEP) are curative in the majority of patients, including advanced, metastatic cases. According to current urooncology guidelines all non-seminoma patients harbouring post-chemotherapy residual masses of ≥ 1 cm should undergo salvage retroperitoneal lymph node dissection (RPLND). However, only 10% of residual tumors contain viable disease. OBJECTIVE To assess patient outcomes and complications considering different treatment regimens and clinical characteristics. MATERIALS AND METHODS In a retrospective cross-sectional study patients (n=127) who underwent postchemotherapy RPLND between 2007 and 2023 at our referral center were evaluated. The patients received systemic treatment at various oncology centers. The number of BEP cycles received were occasionally different from standard. Only patients with normal postchemotherapy serum tumor markers and primary testicular or extragonadal germ cell neoplasms were included. Treatment groups were established according to the number of BEP cycles received, and the extent of RPLND (bilateral or modified template). Treatment outcomes and complications were assessed. RESULTS Standard 3-4 courses of BEP were received by 100 (78,7%) patients, while 11 (8,7%) patients underwent less, and 16 (12,6%) more courses than standard. On histopathologic evaluation viable germ cell tumor, teratoma, and necrosis/fibrosis was present in 26 (20,5%), 67 (52,7%) and 34 (26,8%) of specimen, respectively. In the 5-6 BEP series subgroup high rate of viable disease (37,5%) was found and significantly more nephrectomies were performed, than other chemotherapy subgroups. Extratesticular GCT, viable disease in residual mass or progression after RPLND indicated lower survival. Mild (Clavien-Dindo I-II) or no postoperative complications were reported in 93,7% of cases. CONCLUSIONS The study suggests no significant benefit from exceeding 3-4 courses of BEP. Timely salvage RPLND should be performed in high volume centers for optimal treatment outcomes with acceptable complication rates. Adherence to the Heidenreich criteria is advisable where practical.
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Affiliation(s)
| | - Zsuzsanna Ujfaludi
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary; Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér, 13, Szeged H-6720, Hungary
| | - Krisztina Biró
- National Institute of Oncology, Dept. of Genitourinary Oncology and Clinical Pharmacology, Budapest, Hungary
| | - Zoltán Gábor Páhi
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary; Hungarian Centre of Excellence for Molecular Medicine (HCEMM), Genome Integrity and DNA Repair Core Group, Budapesti út 9, Szeged H-6728, Hungary; Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér, 13, Szeged H-6720, Hungary
| | - István Buzogány
- Péterfy Sándor Hospital, Dept. of Urology, Budapest, Hungary
| | - Farkas Sükösd
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tibor Pankotai
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary; Hungarian Centre of Excellence for Molecular Medicine (HCEMM), Genome Integrity and DNA Repair Core Group, Budapesti út 9, Szeged H-6728, Hungary; Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér, 13, Szeged H-6720, Hungary.
| | - Tamás Beöthe
- Péterfy Sándor Hospital, Dept. of Urology, Budapest, Hungary.
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Tufano A, Cilio S, Spena G, Izzo A, Castaldo L, Grimaldi G, Muscariello R, Franzese D, Quarto G, Autorino R, Passaro F, Perdonà S. Unilateral Post-Chemotherapy Robot-Assisted Retroperitoneal Lymph Node Dissection for Stage II Non-Seminomatous Germ Cell Tumors: Sexual and Reproductive Outcomes. Cancers (Basel) 2024; 16:2231. [PMID: 38927936 PMCID: PMC11201837 DOI: 10.3390/cancers16122231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
We aimed to report sexual and reproductive outcomes following post-chemotherapy robot-assisted retroperitoneal unilateral lymph node dissection (PC-rRPLND) for non-seminomatous germ cell tumors (NSGCTs) at a high-volume cancer center. We collected records regarding sexual and reproductive outcomes of patients undergoing unilateral PC-rRPLND for stage II NSGCTs from January 2018 to November 2021. Preoperative and postoperative (at 12 months) ejaculatory function as well as erectile function, based on the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS), were assessed. Only patients with a pre-operative IIEF-5 of ≥22 and EHS of ≥3 were included in this analysis. Overall, 22 patients undergoing unilateral PC-rRPLND met the inclusion criteria. Of these, seven (31.8%) patients presented an andrological disorder of any type after PC-rRPLND. Specifically, retrograde ejaculation was present in three (13.6%) patients and hypospermia was present in one (4.5%) patient. Moreover, three (13.6%) patients yielded erectile dysfunction (IIEF-5 < 22 and/or EHS < 3). Lastly, two (9.1%) succeeded in naturally conceiving a child after PC-rRPLND. Retrograde ejaculation is confirmed to be one of the most common complications of PC-rRPLND. Moreover, a non-negligible number of patients experience erectile dysfunction.
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Affiliation(s)
- Antonio Tufano
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” Rome University, 00161 Rome, Italy
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Gianluca Spena
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Raffaele Muscariello
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Dario Franzese
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Giuseppe Quarto
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Francesco Passaro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
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Gille R, Allignet B, Izarn F, Peyrat P, Boyle H, Fléchon A. Bone Metastases in Non-Seminomatous Germ Cell Tumors: A 20-Year Retrospective Analysis. J Clin Med 2024; 13:3280. [PMID: 38892991 PMCID: PMC11172778 DOI: 10.3390/jcm13113280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Non-seminomatous germ cell tumors (NSGCTs) represent a rare yet the most prevalent malignancy among young men. Bone metastases (BMs) are exceedingly uncommon in this neoplasm, and available data regarding the initial disease presentation, survival outcomes, and prognostic significance of BMs are limited. Methods: We conducted a retrospective analysis of 40 NSGCT patients with BMs treated between 2001 and 2021 in our tertiary care center. The cohort was stratified into synchronous (n = 29) and metachronous (n = 11) groups based on the presence of BM at diagnosis or only at relapse, respectively. We assessed overall survival (OS), progression-free survival (PFS), disease presentation, and treatments. Results: After a median follow-up of 93 months, the 5-year PFS and OS rates were 37.6% and 53.9% in the synchronous group and 18.2% and 36.4% in the metachronous group, respectively. At the initial diagnosis, most patients were classified into the IGCCCG poor prognostic group (n = 34, 85%). BMs were mostly asymptomatic (n = 23, 57.5%), involved the spine (n = 37, 92.5%), and could become visible only after disease response (n = 4, 10%). A pathological examination of resected bone lesions after first-line treatment revealed necrosis (n = 5, 71.4%), teratoma, or seminoma (both n = 1, 14.3%). At first relapse, eight patients in the synchronous group did not experience bone recurrence, while eight patients experienced recurrence at the initial affected bone site. Conclusions: In NSGCT patients, BMs often present asymptomatically and may initially be unnoticed. However, these patients may have a poorer prognosis compared to those in the IGCCCG poor prognostic group. Further studies including control groups are needed to assess the independent prognostic significance of BMs.
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Affiliation(s)
- Romane Gille
- Campus Lyon Sud Charles Mérieux, University Claude-Bernard Lyon 1, 69921 Oullins-Pierre-Bénite, France;
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
| | - Benoît Allignet
- Department of Radiation Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France;
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1 , CNRS, Inserm, CREATIS UMR 5220, U1294, 69621 Lyon, France
| | - Floriane Izarn
- Campus Lyon Sud Charles Mérieux, University Claude-Bernard Lyon 1, 69921 Oullins-Pierre-Bénite, France;
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
| | - Patrice Peyrat
- Department of Surgery, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France;
| | - Helen Boyle
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69673 Lyon Cedex, France; (H.B.); (A.F.)
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Rosenvilde JJ, Lauritsen J, Bandak M, Wagner T, Agerbæk M, Dysager L, Aagaard M, Daugaard G. Postchemotherapy Retroperitoneal Lumpectomy in Patients with Nonseminoma Testicular Cancer: A Nationwide Study. Eur Urol Oncol 2024; 7:589-596. [PMID: 38199869 DOI: 10.1016/j.euo.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Optimal treatment outcomes in patients with metastatic nonseminoma testicular cancer are achieved with chemotherapy and subsequent surgery in cases with residual tumor. In Denmark, postchemotherapy retroperitoneal lumpectomy (RPLP) is performed in patients with residual tumors >1 cm. There is a need to clarify whether this surgical method provides acceptable treatment results. Our objective was to describe morbidity and oncological outcomes of postchemotherapy RPLP. METHODS This was a retrospective population-based multicenter study including patients with nonseminoma testicular cancer and postchemotherapy RPLP performed in Denmark between 1990 and 2015. A total of 219 patients were eligible, with median follow-up of 19 yr. Postoperative complications were evaluated according to the Clavien-Dindo classification. The cumulative incidence of recurrence inside or outside the borders of a bilateral surgical template, progression-free survival (PFS), and overall survival estimates were calculated using the Kaplan-Meier method. KEY FINDINGS AND LIMITATIONS After median follow-up of 19 yr, 31/219 patients (14%) experienced a surgical complication, of which 5% were Clavien-Dindo grade ≥III. In total, 37 patients experienced a recurrence. The 5-yr, 10-yr, and 20-yr cumulative risk of recurrence inside a bilateral template was 4.3%, 5.9%, and 5.9%, respectively. The 10-yr PFS rate was 83% and the 10-yr overall survival rate was 96%. The main limitation of the study is the retrospective design. CONCLUSIONS AND CLINICAL IMPLICATIONS With few patients experiencing a major postoperative complication and a 10-yr cumulative rate of 5.9% for recurrence inside a bilateral surgical template, postchemotherapy RPLP appears to be a safe alternative to template surgery for disseminated nonseminoma. PATIENT SUMMARY We looked at minimal surgery to remove tumor tissue remaining after chemotherapy in patients with testicular cancer. We found a low frequency of complications, tumor recurrence, and death.
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Affiliation(s)
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Pathology, Herlev Hospital, Copenhagen, Denmark
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Mikael Aagaard
- Department of Urology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Małkiewicz B, Świrkosz G, Lewandowski W, Demska K, Szczepaniak Z, Karwacki J, Krajewski W, Szydełko T. Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives. Curr Oncol Rep 2024; 26:318-335. [PMID: 38430323 PMCID: PMC11021343 DOI: 10.1007/s11912-024-01511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions. RECENT FINDINGS RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
| | - Gabriela Świrkosz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Lewandowski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Katarzyna Demska
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Zuzanna Szczepaniak
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
| | - Jakub Karwacki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
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9
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Heidenreich A, Paffenholz P, Hartmann F, Seelemeyer F, Pfister D. Retroperitoneal Lymph Node Dissection in Clinical Stage IIA/B Metastatic Seminoma: Results of the COlogne Trial of Retroperitoneal Lymphadenectomy In Metastatic Seminoma (COTRIMS). Eur Urol Oncol 2024; 7:122-127. [PMID: 37438222 DOI: 10.1016/j.euo.2023.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/06/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Radiation therapy and systemic chemotherapy are recommended treatment options in marker-negative clinical stage (CS) IIA/B seminoma. Despite high cure rates of 82-94%, both therapeutic options are associated with significant long-term toxicities. OBJECTIVE To evaluate the feasibility, oncological efficacy, and treatment-associated morbidity of primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) in CS IIA/B seminoma. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-arm, clinical phase 2 trial including CS IIA/B seminoma patients was conducted. INTERVENTION Primary nerve-sparing retroperitoneal lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relapse-free and overall survival, surgery-associated complications according to the Clavien-Dindo classification, and Kaplan-Meier methods for survival calculation were assessed. RESULTS AND LIMITATIONS Thirty patients at a mean age of 39.1 (34-52) yr with marker-negative CS IIA and IIB seminomas were recruited. The median follow-up was 22 (8-30) mo. Nineteen (63%) and 11 (36%) patients were diagnosed with stages IIA and B, respectively, at the time of primary diagnosis. Fourteen (47%) and 16 (53%) patients were diagnosed with CS IIA and IIB, respectively, at the time of nsRPLND. Twenty-seven and three patients underwent open and robot-assisted nsRPLND, respectively. The median operating room time was 125 (115-145) min, median blood loss was <150 ml, and median time of hospitalization was 4.5 (3-9) d. Four (13%) patients experienced Clavien-Dindo grade 3a complications. Lymph node histology revealed seminoma in 25 (80%) patients; two and three patients demonstrated embryonal carcinoma and benign disease, respectively. Sixteen patients underwent a serum analysis of miR371 preoperatively, which predicted metastatic disease in 12/13 and benign histology in 3/3 patients. Three of 30 (10%) patients developed an outfield relapse 4, 6, and 9 mo postoperatively and were salvaged by systemic chemotherapy. Limitations are the low patient number and length of follow-up. CONCLUSIONS The nsRPLND approach results in a high cure rate at midterm follow-up and is associated with a low frequency of treatment-associated morbidities, making this approach a feasible alternative to radiation therapy or systemic chemotherapy. PATIENT SUMMARY The standard treatment of clinical stage IIA/B seminomas is radiation therapy or chemotherapy, which results in a significantly increased frequency of long-term toxicity and secondary neoplasms. In this trial, we demonstrate that nerve-sparing retroperitoneal lymph node dissection is a feasible therapeutic approach with low morbidity and high oncological efficacy.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Florian Hartmann
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Felix Seelemeyer
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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10
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van Schaik J, Witt D, Albers L, Wever J, Elzevier H, Hamming J. Pilot Study on Feasibility and Outcome of a Nerve-Preserving Aortoiliac Exposure Technique. Ann Vasc Surg 2024; 98:388-397. [PMID: 37390965 DOI: 10.1016/j.avsg.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Dysfunctional ejaculation is a common complication following open aortoiliac aneurysm surgery. It may occur in 49-63% of patients and is caused by iatrogenic damage to the sympathetic lumbar splanchnic nerves and superior hypogastric plexus. A nerve-preserving operative technique based on a unilateral right-sided approach to the abdominal aorta, was implemented in clinical practice. The aim of this pilot study was to establish the safety and feasibility of the technique, and whether a sympathetic pathway and ejaculatory function was preserved. METHODS Patients were asked to fill out questionnaires preoperatively, and 6 weeks, 6 months, and 9 months postoperatively. The International Index of Erectile Function, Cleveland Clinic Incontinence Score (CCIS), Patient assessment of constipation symptoms (Pac-Sym), and International Consultation on Incontinence Questionnaire on male lower urinary tract symptoms were used. Surgeons were asked to complete a technical feasibility questionnaire. RESULTS Twenty-four patients undergoing aortoiliac aneurysm surgery were included. The nerve-sparing phase of the procedure added an average of 5-10 min of operating time and was technically feasible in twenty-two patients. No major complications occurred during nerve-sparing exposure. Fifteen of twenty-four patients were sexually active at some point throughout the study. No postoperative loss of ejaculation was seen in sexually active patients. CCIS, Pac-sym, International Index of Erectile Function, and Incontinence Questionnaire on male lower urinary tract symptoms scores remained similar throughout the study. CONCLUSIONS Nerve-preserving aortoiliac reconstruction surgery is safe and feasible. Ejaculatory function is preserved. Given the low number of patients in the study, further research is needed to provide robust data.
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Affiliation(s)
- Jan van Schaik
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Daniël Witt
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leonore Albers
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan Wever
- Department of Surgery, Haga Teaching Hopsital, The Hague, The Netherlands
| | - Henk Elzevier
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jaap Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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11
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Gulino G, Distante A, Akhundov A, Bassi PF. Male infertility and urological tumors: Pathogenesis and therapeutical implications. Urologia 2023; 90:622-630. [PMID: 37491831 PMCID: PMC10623618 DOI: 10.1177/03915603221146147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/22/2022] [Indexed: 07/27/2023]
Abstract
Most genitourinary tract cancers have a negative impact on male fertility. Although testicular cancers have the worst impact, other tumors such as prostate, bladder, and penis are diagnosed early and treated in relatively younger patients in which couple fertility can be an important concern. The purpose of this review is to highlight both the pathogenetic mechanisms of damage to male fertility in the context of the main urological cancers and the methods of preserving male fertility in an oncological setting, in light of the most recent scientific evidence. A systematic review of available literature was carried out on the main scientific search engines, such as PubMed, Clinicaltrials.Gov, and Google scholar. Three hundred twenty-five relevant articles on this subject were identified, 98 of which were selected being the most relevant to the purpose of this review. There is a strong evidence in literature that all of the genitourinary oncological therapies have a deep negative impact on male fertility: orchiectomy, partial orchiectomy, retroperitoneal lymphadenectomy (RPLND), radical cystectomy, prostatectomy, penectomy, as well as radiotherapy, chemotherapy, and hormonal androgen suppression. Preservation of fertility is possible and includes cryopreservation, hormonal manipulation with GnRH analogs before chemotherapy, androgen replacement. Germ cell auto transplantation is an intriguing strategy with future perspectives. Careful evaluation of male fertility must be a key point before treating genitourinary tumors, taking into account patients' age and couples' perspectives. Informed consent should provide adequate information to the patient about the current state of his fertility and about the balance between risks and benefits in oncological terms. Standard approaches to genitourinary tumors should include a multidisciplinary team with urologists, oncologists, radiotherapists, psycho-sexologists, andrologists, gynecologists, and reproductive endocrinologists.
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Affiliation(s)
- G Gulino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Distante
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Akhundov
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - PF Bassi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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12
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Saltzman AF, Hensley P, Ross J, Woo L, Billmire D, Rescorla F, Puri D, Patel S, Pierorazio P, Bagrodia A, Cary C, Cost NG. Critical elements of pediatric testicular germ cell tumors surgery. Semin Pediatr Surg 2023; 32:151343. [PMID: 38006835 DOI: 10.1016/j.sempedsurg.2023.151343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Children, adolescents and young adults with testicular germ cell tumors require appropriate surgical care to insure excellent outcomes. This article presents the most critical elements, and their basis in evidence, for surgery in this population. Specifically, the importance of inguinal radical orchiectomy for malignant tumors, partial orchiectomy for prepubertal tumors and normal serum tumor markers, and the appropriate use of post-chemotherapy retroperitoneal lymph node dissection in those with residual retroperitoneal masses.
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Affiliation(s)
| | - Patrick Hensley
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Jonathan Ross
- Department of Urology, Rush University, Chicago, IL, USA
| | - Lynn Woo
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Deborah Billmire
- Department of Pediatric Surgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Frederick Rescorla
- Department of Pediatric Surgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Dhruv Puri
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Sunil Patel
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Aditya Bagrodia
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Nicholas G Cost
- Division of Urology, Department of Surgery at the University of Colorado School of Medicine, Aurora, CO, USA; The Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO, USA.
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13
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Franzese D, Tufano A, Izzo A, Muscariello R, Grimaldi G, Quarto G, Castaldo L, Rossetti S, Pandolfo SD, Desicato S, Del Prete P, Ferro M, Pignata S, Perdonà S. Unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection in Stage II non-seminomatous germ cell tumor: A tertiary care experience. Asian J Urol 2023; 10:440-445. [PMID: 38024429 PMCID: PMC10659970 DOI: 10.1016/j.ajur.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) represents an integral component of the management of patients with non-seminomatous germ cell tumor (NSGCT). Modified templates have been proposed to minimize the surgical morbidity of the procedure. Moreover, the implementation of robotic surgery in this setting has been explored. We report our experience with unilateral post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-rRPLND) for clinical Stages IIA and IIB NSGCTs. Methods A retrospective single institution review was performed including 33 patients undergoing PC-rRPLND for Stages IIA and IIB NSGCTs between January 2015 and February 2019. Following orchiectomy, patients were scheduled for chemotherapy with three cycles of bleomycin-etoposide-cisplatin. Patients with a residual tumor of <5 cm and an ipsilateral metastatic disease on pre- and post-chemotherapy CT scans were eligible for a unilateral template in absence of rising tumor markers. Descriptive statistics were provided for demographics, clinical characteristics, intraoperative and postoperative parameters. Perioperative, oncological, and functional outcomes were recorded. Results Overall, 7 (21.2%) patients exhibited necrosis or fibrosis; 14 (42.4%) had mature teratoma; and 12 (36.4%) had viable tumor at final histology. The median lymph node size at surgery was 25 (interquartile range [IQR] 21-36) mm. Median operative time was 180 (IQR 165-215) min and no major postoperative complications were observed. Anterograde ejaculation was preserved in 75.8% of patients. Median follow-up was 26 (IQR 19-30) months and a total of three recurrences were recorded. Conclusion PC-rRPLND is a reliable and technically reproducible procedure with safe oncological outcomes and acceptable postoperative ejaculatory function in well selected patients with NSGCTs.
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Affiliation(s)
- Dario Franzese
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Antonio Tufano
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University, Rome, Italy
| | - Alessandro Izzo
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Raffaele Muscariello
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Giovanni Grimaldi
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Giuseppe Quarto
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Luigi Castaldo
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Sabrina Rossetti
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Sonia Desicato
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Paola Del Prete
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Naples, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Sandro Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori “Fondazione G. Pascale”, IRCCS, Naples, Italy
| | - Sisto Perdonà
- Department of Urology, National Cancer Institute, Pascale Foundation, Naples, Italy
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14
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Patrikidou A, Cazzaniga W, Berney D, Boormans J, de Angst I, Di Nardo D, Fankhauser C, Fischer S, Gravina C, Gremmels H, Heidenreich A, Janisch F, Leão R, Nicolai N, Oing C, Oldenburg J, Shepherd R, Tandstad T, Nicol D. European Association of Urology Guidelines on Testicular Cancer: 2023 Update. Eur Urol 2023; 84:289-301. [PMID: 37183161 DOI: 10.1016/j.eururo.2023.04.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
CONTEXT Each year the European Association of Urology (EAU) produce a document based on the most recent evidence on the diagnosis, therapy, and follow-up of testicular cancer (TC). OBJECTIVE To represent a summarised version of the EAU guidelines on TC for 2023 with a focus on key changes in the 2023 update. EVIDENCE ACQUISITION A multidisciplinary panel of TC experts, comprising urologists, medical and radiation oncologists, and pathologists, reviewed the results from a structured literature search to compile the guidelines document. Each recommendation in the guidelines was assigned a strength rating. EVIDENCE SYNTHESIS For the 2023 EAU guidelines on TC, a review and restructure were undertaken. The key changes incorporated in the 2023 update include: new supporting text regarding venous thromboembolism prophylaxis in males with metastatic germ cell tumours receiving chemotherapy; quality of life after treatment; an update of the histological classifications and inclusion of the World Health Organization 2022 pathological classification; inclusion of the revalidation of the 1997 International Germ Cell Cancer Collaborative Group prognostic risk factors; and a new section covering oncology treatment protocols. CONCLUSIONS The 2023 version of the EAU guidelines on TC include the highest available scientific evidence to standardise the management of TC. Better stratification and optimisation of treatment modalities will continue to improve the high survival rates for patients with TC. PATIENT SUMMARY This article presents a summary of the European Association of Urology guidelines on testicular cancer published in 2023 and includes the latest recommendations for management of this disease. The guidelines are a valuable resource that may help patients in understanding treatment recommendations.
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Affiliation(s)
- Anna Patrikidou
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Joost Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Isabel de Angst
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Domenico Di Nardo
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Carmen Gravina
- Department of Urology, Sant'Andrea Hospital-Sapienza University, Rome, Italy
| | - Hendrik Gremmels
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ricardo Leão
- Department of Urology, Faculty of Medicine, University of Coimbra, Clinical Academic Center of Coimbra, Coimbra, Portugal
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christoph Oing
- Department of Oncology, Freeman Hospital NHS Foundation Trust, London, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - Robert Shepherd
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Torgrim Tandstad
- Department of Oncology, The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer research, London, UK.
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15
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Branger N, Bladou F, Verhoest G, Knipper S, Robert G, Bernhard JC, Beauval JB, Khaddad A, Mauger De Varennes A, Fléchon A, Walz J, Bageot AS, Doumerc N, Rouprêt M, Murez T. Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes. World J Urol 2023; 41:2405-2411. [PMID: 37507528 DOI: 10.1007/s00345-023-04536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To evaluate the feasibility, safety, and early oncologic outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND) for metastatic germ cell tumors (mGCT). METHODS We retrospectively analyzed patients from four tertiary centers who underwent PC-RARPLND for mGCT, from 2011 to 2021. Previous treatment of mGCT, intraoperative and postoperative complications, and early oncologic outcomes were assessed. RESULTS Overall, 66 patients were included. The majority of patients had non-seminoma mTGCT (89%). Median size of retroperitoneal lymph node (RLN) before surgery was 26 mm. Templates of PC-RARPLND were left modified, right modified, and full bilateral in 56%, 27%, and 14%, respectively. Median estimated blood loss and length of stay were 50 mL [50-150] and 2 [1-3] days. Four patients (6.1%) had a vascular injury, only one with significant blood loss and conversion to open surgery (OS). Two other patients had a conversion to OS for difficulty of dissection. No patient had transfusion, most frequent complications were ileus (10.6%) and symptomatic lymphorrea (7.6%) and no complications grade IIIb or more occurred. With a median follow-up of 16 months, two patients had a relapse, all outside of the surgical template (one in the retrocrural space with reascending markers, one in lungs). CONCLUSION PC-RARPLND is a challenging surgery. In expert centers and for selected patients, it seemed safe and feasible, with a low morbidity. Further prospective evaluation of this procedure and long-term oncologic results are needed.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France.
| | - Franck Bladou
- Department of Urology, CHU Bordeaux, Bordeaux, France
| | | | - Sophie Knipper
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | | | | | | | | | - Aude Fléchon
- Department of Oncology, Centre Léon Bérard, Lyon, France
| | - Jochen Walz
- Department of Urology, Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | | | - Morgan Rouprêt
- Department of Urology, La Pitié Salpêtrière, Paris, France
| | - Thibault Murez
- Department of Urology, CHU Montpellier, Montpellier, France
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16
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Gerdtsson A, Torisson G, Thor A, Grenabo Bergdahl A, Almås B, Håkansson U, Törnblom M, Negaard HFS, Glimelius I, Halvorsen D, Karlsdóttir Á, Haugnes HS, Larsen SM, Holmberg G, Wahlqvist R, Tandstad T, Cohn-Cedermark G, Ståhl O, Kjellman A. Validation of a prediction model for post-chemotherapy fibrosis in nonseminoma patients. BJU Int 2023; 132:329-336. [PMID: 37129962 DOI: 10.1111/bju.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To validate Vergouwe's prediction model using the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) RETROP database and to define its clinical utility. MATERIALS AND METHODS Vergouwe's prediction model for benign histopathology in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) uses the following variables: presence of teratoma in orchiectomy specimen; pre-chemotherapy level of alpha-fetoprotein; β-Human chorionic gonadotropin and lactate dehydrogenase; and lymph node size pre- and post-chemotherapy. Our validation cohort consisted of patients included in RETROP, a prospective population-based database of patients in Sweden and Norway with metastatic nonseminoma, who underwent PC-RPLND in the period 2007-2014. Discrimination and calibration analyses were used to validate Vergouwe's prediction model results. Calibration plots were created and a Hosmer-Lemeshow test was calculated. Clinical utility, expressed as opt-out net benefit (NBopt-out ), was analysed using decision curve analysis. RESULTS Overall, 284 patients were included in the analysis, of whom 130 (46%) had benign histology after PC-RPLND. Discrimination analysis showed good reproducibility, with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95% confidence interval 0.77-0.87) compared to Vergouwe's prediction model (AUC between 0.77 and 0.84). Calibration was acceptable with no recalibration. Using a prediction threshold of 70% for benign histopathology, NBopt-out was 0.098. Using the model and this threshold, 61 patients would have been spared surgery. However, only 51 of 61 were correctly classified as benign. CONCLUSIONS The model was externally validated with good reproducibility. In a clinical setting, the model may identify patients with a high chance of benign histopathology, thereby sparing patients of surgery. However, meticulous follow-up is required.
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Affiliation(s)
- Axel Gerdtsson
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Gustav Torisson
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Anna Thor
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Grenabo Bergdahl
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Magnus Törnblom
- Section of Urology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Surgery, Visby County Hospital, Visby, Sweden
| | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT-The Arctic University of Norway, Tromsø, Norway
| | | | - Göran Holmberg
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Anders Kjellman
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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17
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Gilligan TD. Resection of Residual Masses After Chemotherapy for Metastatic Nonseminomatous Germ Cell Tumors in Adolescents and Adults. J Clin Oncol 2023; 41:3899-3904. [PMID: 37410968 DOI: 10.1200/jco.23.00654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in the Journal of Clinical Oncology, to patients seen in their own clinical practice.Optimal treatment of patients with testicular germ cell tumors requires a coordinated multidisciplinary approach, so that surgery, chemotherapy, and, when appropriate, radiation therapy can be integrated into a coherent and comprehensive treatment plan. Nonseminomatous germ cell tumors (NSGCT) are often a mixture of teratoma and cancer (choriocarcinoma, embryonal carcinoma, seminoma, and/or yolk sac tumor). While the cancers are highly sensitive to and often cured by chemotherapy, teratoma is resistant to chemotherapy and radiation therapy and generally must be resected surgically to be successfully treated. Therefore, the standard of care for metastatic NSGCT is to resect all resectable residual masses after chemotherapy. If such resection reveals only teratoma and/or necrosis/fibrosis, then patients are put on a surveillance schedule to monitor for relapse. If viable cancer is found and there are positive margins or 10% or more of any of the residual masses consists of viable cancer, then two cycles of adjuvant chemotherapy should be considered.
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18
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Nalavenkata S, Li T, Patel MI. Nerve-sparing technique in RPLND for testicular cancer. Curr Opin Urol 2023; 33:281-287. [PMID: 37132366 DOI: 10.1097/mou.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE OF REVIEW The management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. RECENT FINDINGS The standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. SUMMARY RPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.
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Affiliation(s)
- Sunny Nalavenkata
- Department of Urology, Westmead Hospital, Westmead, and Faculty of Medicine and Health, University of Sydney, NSW, Australia
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19
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Evmorfopoulos K, Chasiotis G, Barbatis A, Zachos I, Kouvelos G, Bareka M, Vlachostergios PJ, Arnaoutoglou E, Tzortzis V, Matsagkas M. Complete Vascular Replacement of the Infrarenal Inferior Vena Cava and Abdominal Aorta during Post-Chemotherapy Retroperitoneal Lymph Node Dissection for a Non-Seminomatous Germ Cell Tumor. Curr Oncol 2023; 30:5448-5455. [PMID: 37366895 DOI: 10.3390/curroncol30060412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Testicular germ cell tumors (TGCTs) are the leading cause of cancer-related death in males between the ages of 20 and 40. In the advanced stages, the combination of cisplatin-based chemotherapy and surgical excision of the remaining tumor can cure many of these patients. Vascular procedures may be required during retroperitoneal lymph node dissection (RPLND) in order to achieve the complete excision of all residual retroperitoneal masses. Careful assessment of pre-operative imaging and the identification of patients who could benefit from additional procedures are important for minimizing peri- and postoperative complications. We report on a case of a 27-year-old patient with non-seminomatous TGCT, who successfully underwent post-chemotherapy RPLND with additional infrarenal inferior vena cava (IVC) and complete abdominal aorta replacement using synthetic grafts.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Georgios Chasiotis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Alexandros Barbatis
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Ioannis Zachos
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Metaxia Bareka
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Panagiotis J Vlachostergios
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
- Department of Medical Oncology, IASO Thessalias Hospital, 41500 Larissa, Greece
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece
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20
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Antonelli L, Ardizzone D, Ravi P, Bagrodia A, Mego M, Daneshmand S, Nicolai N, Nazzani S, Giannatempo P, Franza A, Heidenreich A, Paffenholz P, Saoud R, Eggener S, Ho M, Oswald N, Olson K, Tryakin A, Fedyanin M, Naoun N, Javaud C, Fizazi K, King JM, Adra N, Douglawi A, Cary C, Sweeney C, Fankhauser CD. Risk of residual cancer after complete response following first-line chemotherapy in men with metastatic non-seminomatous germ cell tumour and International Germ Cell Cancer Cooperative Group intermediate/poor prognosis: A multi-institutional retrospective cohort study. Eur J Cancer 2023; 182:144-154. [PMID: 36787661 DOI: 10.1016/j.ejca.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Current guidelines recommend surveillance in metastatic non-seminomatous germ cell tumour patients treated with first-line-chemotherapy and a complete clinical response (normalisation of serum tumour markers and residual masses <1 cm). However, this recommendation is based on a series including patients with good prognosis according to International Germ Cell Cancer Cooperative Group prognostic group (IGCCCG-PG). The aim of this study was to analyse the proportion of residual teratoma and survival among patients with intermediate/poor IGCCCG-PG and a complete clinical response after first-line-chemotherapy. MATERIAL & METHODS This is a retrospective study of men with intermediate/poor IGCCCG-PG, who had a complete clinical response after first-line chemotherapy. Patients were either followed by surveillance or treated with post-chemotherapy retroperitoneal lymph node dissection (pcRPLND). RESULTS Between 2009 and 2018, 143 men with intermediate (n = 83) or poor (n = 60) IGCCCG-PG were treated at 11 international centres. Among 33 patients treated with pcRPLND, the specimen showed teratoma and viable cancer in 16 (48%) and 4 (12%). During a median a 7-year follow-up, 20/110 (18%) patients managed with surveillance relapsed, of whom seven (6%) had a retroperitoneal-only relapse versus 2/33 patients managed with pcRPLND relapsed. No difference was observed regarding overall survival (OS) among men treated with pcRPLND or surveillance (5-year OS, 93% and 89%, p-value = 0.35). The median time-to-recurrence among men on surveillance was 1.3 years (range: 0.3-9.1), and the most common sites of relapses included retroperitoneum (11%), chest (5%), and bones (4%). CONCLUSIONS While most men with intermediate/poor IGCCCG-PG harbour teratoma/cancer in the retroperitoneum despite a complete response to first-line-chemotherapy, only 6% managed with surveillance relapsed in the retroperitoneum. There was no significant difference in OS between the two groups.
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Affiliation(s)
- Luca Antonelli
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Switzerland; Department of Urology, Policlinico Umberto I, Rome, Italy
| | | | - Praful Ravi
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Aditya Bagrodia
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | - Michal Mego
- Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovak Republic
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicola Nicolai
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sebastiano Nazzani
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Franza
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany; Department of Urology, Medical University, Vienna, Austria
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Ragheed Saoud
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Matthew Ho
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | | | - Alexey Tryakin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Mikhail Fedyanin
- N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | | | | | - Karim Fizazi
- Institut Gustave Roussy, Villejuif Cedex, France
| | - Jennifer M King
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Nabil Adra
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Antoin Douglawi
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Clint Cary
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Christopher Sweeney
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christian D Fankhauser
- Department of Urology, Luzerner Kantonsspital, University of Lucerne, Switzerland; University of Zurich, Zurich, Switzerland.
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21
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Garg H, Mansour AM, Psutka SP, Kim SP, Porter J, Gaspard CS, Dursun F, Pruthi DK, Wang H, Kaushik D. Robot-assisted retroperitoneal lymph node dissection: a systematic review of perioperative outcomes. BJU Int 2023. [PMID: 36754376 DOI: 10.1111/bju.15986] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To assess the safety and feasibility of robot-assisted retroperitoneal lymph node dissection (R-RPLND) and to compare the perioperative outcomes of R-RPLND with open RPLND (O-RPLND), as RPLND forms an integral part of the management of testis cancer and R-RPLND is a minimally invasive treatment option for this disease. MATERIALS AND METHODS The PubMed® , Scopus® , Cochrane Central Register of Controlled Trials, and Web of Science™ databases were searched for studies reporting perioperative outcomes of primary and post-chemotherapy R-RPLND and studies comparing R-RPLND with O-RPLND. RESULTS The search yielded 42 articles describing R-RPLND, including five comparative studies. The systematic review included 4222 patients (single-arm studies, n = 459; comparative studies, n = 3763). Of 459 patients in the single-arm studies, 271 underwent primary R-RPLND and 188 underwent post-chemotherapy R-RPLND. For primary R-RPLND, the operative time ranged from 175 to 540 min and the major complication rate was 4.1%. For post-chemotherapy R-RPLND, the operative time ranged from 134 to 550 min and the major complication rate was 8.5%. The conversion rate to open surgery was 2.2% in primary R-RPLND and 9.0% in post-chemotherapy R-RPLND. In comparison with O-RPLND, R-RPLND was associated with a lower transfusion rate (14.5% vs 0.9%, P < 0.001) and a lower complication rate (18.5% vs 7.8%, P = 0.002). CONCLUSION Robot-assisted RPLND has acceptable perioperative outcomes in both the primary and post-chemotherapy settings but a notable rate of conversion to open surgery in the post-chemotherapy setting. Compared with O-RPLND, R-RPLND is associated with a lower transfusion rate and fewer overall complications. Given the potential impact of selection bias, the optimal patient selection criteria for R-RPLND remain to be elucidated.
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Affiliation(s)
- Harshit Garg
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Simon P Kim
- Division of Urology, University of Colorado-Denver, Denver, CO, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, WA, USA
| | | | - Furkan Dursun
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Deepak K Pruthi
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health, San Antonio, TX, USA
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22
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Nazzani S, Stagni S, Biasoni D, Catanzaro M, Macchi A, Tesone A, Torelli T, Darisi R, Lo Russo V, Colbacchini C, Lanocita R, Cascella T, Claps M, Giannatempo P, Zimatore M, Cattaneo L, Montanari E, Salvioni R, Nicolai N. Laparoscopic retroperitoneal lymph-node dissection in metastatic nonseminomatous germ-cell tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:257-262. [PMID: 36031470 DOI: 10.1016/j.ejso.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To support laparoscopic post-chemotherapy retroperitoneal lymph-node dissection (L-PC-RPLND) as a potential new standard, we report on a large dataset of patients systematically undergoing L-PC-RPLND. PATIENTS AND METHODS Patients with unilateral residual mass (≥1 cm), normalized markers, limited encasement (<30%) of gross retroperitoneal vessels underwent unilateral L-PC-RPLND with no adjuvant chemotherapy. Surgical performances, histology, hospital stay, complications within 30 days and follow-up visits were recorded. Multivariable linear and logistic regression models were used. RESULTS Between February 2011 and January 2021, 151 consecutive patients underwent L-PC-RPLND. Median size of the residual mass was 25 mm (interquartile range [IQR] 20-35 mm). Overall median operative time was 208 min (IQR 177-241) and was 51 min longer (p-value <0.001) for right L-PC-RPLNDs. Eleven procedures were converted to open surgery. Median number of removed and positive nodes was 11 (IQR 8-16) and 1 (IQR 1-2), respectively. Mean hospital stay was 2 days (IQR 2-3). Nine complications (6%) occurred: two were Clavien-Dindo grade III. Definitive pathology revealed post-pubertal teratoma in 65.6%, fibro-necrotic tissue in 23.8%, teratoma with malignant somatic component in 6.6% and viable tumour in 4.0% patients. In multivariable linear regression models, fibro-necrotic tissue (32 min, CI 8.5-55.5; p < 0.01) and residual volume (1.05 min, CI 0.24-1.85; p < 0.01) achieved independent predictor status for longer operative time. All patients, but one, are alive and disease-free after a median follow-up of 22 months (IQR 10, 48). CONCLUSION L-PC-RPLND, when adequately planned, is safe and effective for most patients with low to medium volume residual masses.
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Affiliation(s)
- Sebastiano Nazzani
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Silvia Stagni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Catanzaro
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberto Macchi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonio Tesone
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Torelli
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ruggero Darisi
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Vito Lo Russo
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Claudia Colbacchini
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Università degli Studi di Padova, Italy
| | - Rodolfo Lanocita
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Melanie Claps
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Zimatore
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Cattaneo
- Pathology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Roberto Salvioni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Testis surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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23
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Parkin CJ, Sharma A, Winter M. How to do an open midline extraperitoneal bilateral retroperitoneal lymph node dissection for non-seminomatous germ cell tumour. ANZ J Surg 2023; 93:337-338. [PMID: 36448646 DOI: 10.1111/ans.18182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
Retroperitoneal lymph node dissection, remains a crucial step in the management of patients with non-seminomatous germ cell tumours who have undergone chemotherapy. It is a technically challenging operation with a number of techniques that have been advocated. We outline the midline, extraperitoneal approach to perform a bilateral template lymph node dissection.
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Affiliation(s)
- Cameron James Parkin
- Department of Urology, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia.,North Shore Urology Research Group, Royal North Shore Hospital, New South Wales, Australia.,Department of Surgery, University of Notre Dame, Sydney, New South Wales, Australia
| | - Aditya Sharma
- Department of Urology, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia.,North Shore Urology Research Group, Royal North Shore Hospital, New South Wales, Australia
| | - Matthew Winter
- Department of Urology, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia.,North Shore Urology Research Group, Royal North Shore Hospital, New South Wales, Australia
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24
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The Importance of Repeat Imaging Prior to Treatment Decision-making in Testicular Cancer: Commentary From the Inaugural Global Society of Rare Genitourinary Tumors Summit. Clin Genitourin Cancer 2022; 21:418.e1-418.e6. [PMID: 36624008 DOI: 10.1016/j.clgc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Testicular cancer is a rare cancer that often affects young and otherwise healthy patients. Imaging plays a critical role in the staging and surveillance of patients with testicular cancer. Indeterminate findings on staging or surveillance imaging, can lead to challenging management decisions for clinicians and patients. In this article, we review the importance of short-interval, repeat imaging for several scenarios faced by patients with testicular cancer and their clinicians. The challenging scenarios and recommendations provided in this article summarize the discussion from the inaugural Global Society of Rare Genitourinary Tumors (GSRGT) Summit held on December 11-12, 2020.
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25
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Nestler T, Schmelz H, Müller AC, Seidel C. [Multimodal treatment of testicular cancer: chemotherapy, surgery or radiotherapy?]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:1315-1323. [PMID: 36224397 DOI: 10.1007/s00120-022-01953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metastatic testicular germ cell tumors patients require histology- and stage-appropriate therapy to achieve optimal therapeutic outcomes. OBJECTIVES This work focuses on the interdisciplinary presentation of current recommendations for the treatment of metastatic germ cell tumor patients. MATERIALS AND METHODS The interdisciplinary recommendations were formulated based on the German S3 guideline and supplemented by recent literature. RESULTS Using a stage-specific and guideline-based treatment approach, interdisciplinary cooperation between urology, oncology, and radiotherapy is mandatory to successfully achieve a high rate of cure and, in the case of complex advanced tumors, also the most effective therapy possible. The question of optimal treatment approaches for seminoma in cSII A/B remains particularly challenging. CONCLUSION Since treatment of advanced or multiple relapsed germ cell tumor patients remains complex, patients should be referred for an online second opinion ( https://urologie.ekonsil.org ).
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Affiliation(s)
- Tim Nestler
- Klinik für Urologie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland.
| | - Hans Schmelz
- Klinik für Urologie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstraße 170, 56072, Koblenz, Deutschland
| | - Arndt-Christian Müller
- Klinik für Radioonkologie und Strahlentherapie, RKH Kliniken Ludwigsburg-Bietigheim, Ludwigsburg, Deutschland
| | - Christoph Seidel
- Klinik Onkologie, Hämatologie und Stammzelltransplantation mit Abteilung für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Abstract
Testicular cancer is a curable cancer. The success of physicians in curing the disease is underpinned by multidisciplinary advances. Cisplatin-based combination chemotherapy and the refinement of post-chemotherapy surgical procedures and diagnostic strategies have greatly improved long term survival in most patients. Despite such excellent outcomes, several controversial dilemmas exist in the approaches to clinical stage I disease, salvage chemotherapy, post-chemotherapy surgical procedures, and implementing innovative imaging studies. Relapse after salvage chemotherapy has a poor prognosis and the optimal treatment is not apparent. Recent research has provided insight into the molecular mechanisms underlying cisplatin resistance. Phase 2 studies with targeted agents have failed to show adequate efficacy; however, our understanding of cisplatin resistant disease is rapidly expanding. This review summarizes recent advances and discusses relevant issues in the biology and management of testicular cancer.
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Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Providence, RI, USA
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27
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Murez T, Fléchon A, Branger N, Savoie PH, Rocher L, Camparo P, Neuville P, Ferretti L, Van Hove A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: testicular germ cell cancer. Prog Urol 2022; 32:1066-1101. [DOI: 10.1016/j.purol.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022]
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Conduit C, Hong W, Martin F, Thomas B, Lawrentschuk N, Goad J, Grimison P, Ahmadi N, Tran B, Lewin J. A meta-analysis of clinicopathologic features that predict necrosis or fibrosis at post-chemotherapy retroperitoneal lymph node dissection in individuals receiving treatment for non-seminoma germ cell tumours. Front Oncol 2022; 12:931509. [PMID: 36059636 PMCID: PMC9428700 DOI: 10.3389/fonc.2022.931509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Post-chemotherapy retroperitoneal lymph node dissection (pcRPLND) for residual nodal masses is a critical component of care in metastatic testicular germ cell tumour (GCT). However, the procedure is not of therapeutic value in up to 50% of individuals in whom histopathology demonstrates post-treatment necrosis or fibrosis alone. Improved diagnostic tools and clinicopathologic features are needed to separate individuals who benefit from pcRPLND and avoid surgery in those who do not. Methods A prospectively registered meta-analysis of studies reporting clinicopathologic features associated with teratoma, GCT and/or necrosis/fibrosis at pcRPLND for metastatic non-seminoma GCT (NSGCT) was undertaken. We examined the effect of various clinicopathologic factors on the finding of necrosis/fibrosis at pcRPLND. The log odds ratios (ORs) of each association were pooled using random-effects models. Results Using the initial search strategy, 4,178 potentially eligible abstracts were identified. We included studies providing OR relating to clinicopathologic factors predicting pcRPLND histopathology, or where individual patient-level data were available to permit the calculation of OR. A total of 31 studies evaluating pcRPLND histopathology in 3,390 patients were eligible for inclusion, including two identified through hand-searching the reference lists of eligible studies. The following were associated with the presence of necrosis/fibrosis at pcRPLND: absence of teratomatous elements in orchidectomy (OR 3.45, 95% confidence interval [CI] 2.94-4.17); presence of seminomatous elements at orchidectomy (OR 2.71, 95% CI 1.37-5.37); normal pre-chemotherapy serum bHCG (OR 1.96, 95% CI 1.62-2.36); normal AFP (OR 3.22, 95% CI 2.49-4.15); elevated LDH (OR 1.72, 95% CI 1.37-2.17); >50% change in mass during chemotherapy (OR 4.84, 95% CI 3.94-5.94); and smaller residual mass size (<2 cm versus >2 cm: OR 3.93, 95% CI 3.23-4.77; <5 cm versus >5 cm: OR 4.13, 95% CI 3.26-5.23). Conclusions In this meta-analysis, clinicopathologic features helped predict the presence of pcRPLND necrosis/fibrosis. Collaboration between centres that provide individual patient-level data is required to develop and validate clinical models and inform routine care to direct pcRPLND to individuals most likely to derive benefits. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021279699.
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Affiliation(s)
- Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Wei Hong
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Felicity Martin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Benjamin Thomas
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jeremy Goad
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Peter Grimison
- Department of Medical Oncology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Nariman Ahmadi
- Department of Urology, Chris O’Brien Lifehouse, Camperdown, NSW, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- ONTrac at Peter Mac, Victorian Adolescence and Young Adult Cancer Service, Melbourne, VIC, Australia
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Nicolai N, Nazzani S, Tesone A, Macchi A, Piva L, Salvioni R, Stagni S, Torelli T, Agostini E, Celso F, Giannatempo P, Procopio G, Avuzzi B, Lanocita R, Cattaneo L, Catanzaro M, Biasoni D. Retroperitoneal lymph-node dissection (RPLND) as upfront management in stage II germ-cell tumours: evaluation of safety and efficacy. TUMORI JOURNAL 2022:3008916221112697. [PMID: 35915559 PMCID: PMC10363949 DOI: 10.1177/03008916221112697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Nicola Nicolai
- Testis Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.,Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Antonio Tesone
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Alberto Macchi
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Luigi Piva
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Roberto Salvioni
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Silvia Stagni
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Tullio Torelli
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Edoardo Agostini
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Francesco Celso
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Patrizia Giannatempo
- Medical Oncology Dept, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giuseppe Procopio
- Medical Oncology Dept, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Barbara Avuzzi
- Radiation Oncology Dept, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Rodolfo Lanocita
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Laura Cattaneo
- Pathology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Mario Catanzaro
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Zor M, Yilmaz S, Topuz B, Kaya E, Yalcin S, Coguplugil AE, Ince ME, Gurdal M. Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours. Aktuelle Urol 2022; 53:325-330. [PMID: 34734394 DOI: 10.1055/a-1469-6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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.
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Affiliation(s)
- Murat Zor
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Sercan Yilmaz
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Bahadir Topuz
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Serdar Yalcin
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | | | - Mehmet Emin Ince
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Mesut Gurdal
- Department of Urology, Gulhane Research and Training Hospital, Ankara, Turkey
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31
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Kalemci S, Kizilay F, Ergun KE, Aliyev B, Simsir A. Postchemotherapy retroperitoneal residual mass resection for germ cell testicular tumors: a single-center experience. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:524-529. [DOI: 10.1590/1806-9282.20211247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/21/2022]
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32
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Gerdtsson A, Thor A, Grenabo Bergdahl A, Almås B, Håkansson U, Törnblom M, Negaard HFS, Glimelius I, Halvorsen D, Karlsdóttir Á, Sagstuen Haugnes H, Engen Andreassen K, Melsen Larsen S, Holmberg G, Wahlqvist R, Tandstad T, Cohn-Cedermark G, Ståhl O, Kjellman A. Unilateral or Bilateral Retroperitoneal Lymph Node Dissection in Nonseminoma Patients with Postchemotherapy Residual Tumour? Results from RETROP, a Population-based Mapping Study by the Swedish Norwegian Testicular Cancer Group. Eur Urol Oncol 2022; 5:235-243. [PMID: 33750683 DOI: 10.1016/j.euo.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The distribution of retroperitoneal lymph node metastases for patients with nonseminoma and a residual tumour of 10-49 mm in a population-based setting is unknown. This information is needed to justify selection of patients for a unilateral template resection. OBJECTIVE To describe the location of retroperitoneal metastases and recurrences in patients with nonseminoma germ cell tumour (NSGCT) with a residual tumour of 10-49 mm. DESIGN, SETTING, AND PARTICIPANTS RETROP is a population-based prospective observational mapping study of 213 patients in Sweden and Norway with a retroperitoneal residual tumour of 10-49 mm who underwent postchemotherapy retroperitoneal lymph node dissection for metastatic NSGCT during 2007-2014 with median follow-up of 100 mo. Patients were classified according to the testis primary tumour and the distribution of unilateral or bilateral lymph node metastases (with reference to the aorta) present on pre- and/or postchemotherapy computed tomography (CT) scans. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The distribution and rate of teratoma or cancer in unilateral or bilateral retroperitoneal fields and the location and rate of retroperitoneal recurrence were measured. RESULTS AND LIMITATIONS In total, 65% of the patients had unilateral retroperitoneal lymph node metastases (RLNMs) on CT scans. Patients with unilateral RLNMs had a low risk of contralateral teratoma or cancer (1.6% for right- and 2.6% for left-sided NSGCT) or retroperitoneal recurrence (0% for right- and 4% for left-sided NSGCT). A weakness of the study is that the pathology specimen could not be fully designated to one specific area for some of the patients. CONCLUSIONS Men with postchemotherapy residual disease of 10-49 mm and unilateral metastases on pre- and postchemotherapy CT scans have a low risk of contralateral disease and should be considered for a unilateral template resection. PATIENT SUMMARY The surgeon can use computed tomography (CT) scans in deciding on the extent of lymph node dissection in patients with testicular cancer.
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Affiliation(s)
- Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
| | - Anna Thor
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Grenabo Bergdahl
- Department of Urology, Gothenburg University, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Magnus Törnblom
- Department of Clinical Science and Education, Section of Urology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Department of Surgery, Visby County Hospital, Visby, Sweden
| | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Unit of Clinical and Experimental Oncology, Uppsala University, Uppsala, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UIT-The Arctic University of Norway, Tromsø, Norway
| | | | | | - Göran Holmberg
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
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Spooner J, Lawen T, Ory J. Triaging urological surgeries to cope with the coronavirus-19 pandemic. Curr Opin Urol 2022; 32:131-140. [PMID: 34939597 PMCID: PMC8815629 DOI: 10.1097/mou.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus-19 (COVID-19) pandemic has led to strains on hospital resources and difficulties in safely and effectively triaging surgical procedures. In this article, we discuss the important considerations for triaging urologic surgeries during a global pandemic, mitigating factors on how to perform surgeries safely, and general guidelines for specific surgeries. RECENT FINDINGS Many urological procedures have been cut back due to the pandemic, with benign disease states being most affected whereas oncology cases affected least. Current recommendations in urology triage life-threatening conditions, or conditions that may lead to life-threatening ailments as a priority for treatment during the pandemic. Additionally, published recommendations have been put forth recommending all surgical patients be screened for COVID-19 to protect staff, prevent disease dissemination, and to educate patients on worse outcomes that can occur if infected with COVID-19 in the postoperative period. SUMMARY COVID-19 has caused worldwide shortages of healthcare resources and increased the need to ethically triage resources to adequately treat the urologic community. These resource limitations have led to increased wait times and cancellations of many urology surgeries that are considered 'elective'.
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Affiliation(s)
- Jesse Spooner
- Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
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34
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New Landmarks Towards Reducing the Treatment Burden for Patients with a Postchemotherapy Residual Retroperitoneal Mass from Nonseminomatous Germ-cell Testicular Tumors. Eur Urol Oncol 2022; 5:244-245. [DOI: 10.1016/j.euo.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 11/22/2022]
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Lloyd P, Hong A, Furrer MA, Lee EWY, Dev HS, Coret MH, Adshead JM, Baldwin P, Knight R, Shamash J, Alifrangis C, Stoneham S, Mazhar D, Wong H, Warren A, Tran B, Lawrentschuk N, Neal DE, Thomas BC. A comparative study of peri-operative outcomes for 100 consecutive post-chemotherapy and primary robot-assisted and open retroperitoneal lymph node dissections. World J Urol 2022; 40:119-126. [PMID: 34599350 DOI: 10.1007/s00345-021-03832-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To describe and compare differences in peri-operative outcomes of robot-assisted (RA-RPLND) and open (O-RPLND) retroperitoneal lymph node dissection performed by a single surgeon where chemotherapy is the standard initial treatment for Stage 2 or greater non-seminomatous germ cell tumour. METHODS Review of a prospective database of all RA-RPLNDs (28 patients) and O-RPLNDs (72 patients) performed by a single surgeon from 2014 to 2020. Peri-operative outcomes were compared for patients having RA-RPLND to all O-RPLNDs and a matched cohort of patients having O-RPLND (20 patients). Further comparison was performed between all patients in the RA-RPLND group (21 patients) and matched O-RPLND group (18 patients) who had previous chemotherapy. RA-RPLND was performed for patients suitable for a unilateral template dissection. O-RPLND was performed prior to the introduction of RA-RPLND and for patients not suitable for RA-RPLND after its introduction. RESULTS RA-RPLND showed improved peri-operative outcomes compared to the matched cohort of O-RPLND-median blood loss (50 versus 400 ml, p < 0.00001), operative duration (150 versus 195 min, p = 0.023) length-of-stay (1 versus 5 days, p < 0.00001) and anejaculation (0 versus 4, p = 0.0249). There was no statistical difference in complication rates. RA-RPLND had lower median lymph node yields although not significant (9 versus 13, p = 0.070). These improved peri-operative outcomes were also seen in the post-chemotherapy RA-RPLND versus O-RPLND analysis. There were no tumour recurrences seen in either group with median follow-up of 36 months and 60 months, respectively. CONCLUSIONS Post-chemotherapy RA-RPLND may have decreased blood loss, operative duration, hospital length-of-stay and anejaculation rates in selected cases and should, therefore, be considered in selected patients. Differences in oncological outcomes require longer term follow-up.
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Affiliation(s)
- Paul Lloyd
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Anne Hong
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Marc A Furrer
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Urology, University Hospital of Bern, Bern, Switzerland.,The Australian Medical Robotics Academy, Melbourne, Australia
| | - Elaine W Y Lee
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Harveer S Dev
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Maurice H Coret
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | | | - Peter Baldwin
- Department of Gynae-Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Richard Knight
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | | | | | - Sara Stoneham
- Department of Oncology, University College London Hospital, London, UK
| | - Danish Mazhar
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Han Wong
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Anne Warren
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - David E Neal
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Benjamin C Thomas
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK. .,Department of Urology, Royal Melbourne Hospital, Melbourne, Australia. .,The Australian Medical Robotics Academy, Melbourne, Australia. .,Department of Surgery, University of Melbourne, Melbourne, Australia.
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Williams ISC, Lahoud J, Gurney H, Arasaratnam M, Patel MI. Outcomes of retroperitoneal lymph node dissection for testicular cancer by a high volume surgeon from Australia: a case for centralisation. ANZ J Surg 2021; 92:1044-1049. [PMID: 34724334 DOI: 10.1111/ans.17323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/27/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are few studies examining retroperitoneal lymph node dissection (RPLND) for testicular cancer in Australia. This study examines the perioperative outcomes, complications and survival rates following RPLND, by a high volume, single surgeon. METHODS A retrospective, case series of a single surgeon, multi-centre study included all patients who underwent RPLND following testicular cancer at Westmead Public Hospital, Westmead Private Hospital, and Macquarie University Hospital 2005-2020. One hundred one patients identified, with 94 having sufficient available data. RESULTS At time of operation, median age was 29.5 years. 84.2% had T1 or T2 primary tumours at diagnosis. Most common RPLND indication was residual mass post-chemotherapy (92.6%), with bleomycin, etoposide and cisplatin (BEP)x3 and BEPx4 most common chemotherapy regimens (50% and 35% respectively). Post-chemotherapy, largest residual mass ranged from 0.9 to 20 cm (median 3.32 cm). Post-chemotherapy, 95.7% masses were found in retroperitoneum (64.4% para-aortic region). 93.6% had open approach. 42.5% had bilateral nerve sparing. Majority (97.1%) did not require blood transfusion. No complications reported in 52.1% of patients. No deaths recorded within 90 days of surgery. At time of analysis, 91.5% had recurrence free survival, and 92.6% overall survival, at a median follow-up since surgery of 47.5 months (range 11 to 200 months). CONCLUSIONS This retrospective study, addressing peri-operative surgical outcomes for RPLND surgery in Australia, is comparable to high-volume international urological centre studies, and shows that centralisation of post-chemotherapy RPLND to an experienced surgeon, results in low perioperative morbidity and mortality.
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Affiliation(s)
| | - John Lahoud
- Specialty of Surgery, University of Sydney, Sydney, Australia
| | - Howard Gurney
- Department of Medical Oncology, Westmead Hospital, Sydney, Australia
| | | | - Manish I Patel
- Specialty of Surgery, University of Sydney, Sydney, Australia.,Department of Urology, Westmead Hospital, Westmead, Australia
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Nappi L, Nichols C, Kollmannsberger C. Narrative review of developing new biomarkers for decision making in advanced testis cancer. Transl Androl Urol 2021; 10:4075-4084. [PMID: 34804849 PMCID: PMC8575592 DOI: 10.21037/tau-20-1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/30/2020] [Indexed: 12/03/2022] Open
Abstract
Management of testicular germ cell tumor (GCT) patients is based on clinical determinants, mainly CT scan and serum tumor markers (alpha-fetoprotein, beta subunit of HCG and LDH). Treatment decisions are usually straightforward for patients with clear evidence of metastatic disease, confirmed either by imaging tests or by unequivocal elevated tumor markers. However, there are several clinical scenarios where the assessment of metastatic disease is complicated by the limited specificity of the current imaging tests and serum tumor markers. These include patients with clinical stage IIA GCT with negative tumor markers and patients with post-chemotherapy residual disease where, in absence of clear indicators of GCT, decision making and patient treatment allocation become challenging. Therefore, more accurate biomarkers are critical to reduce the risk of under-or over-treatment and to always deliver the most optimal therapy. The objectives of this narrative review are to review the available publications about micro-RNAs in GCT s and their potential clinical applications. Two clusters of micro-RNAs, miR-371a-3p and miR-302/367, specifically expressed by both seminoma and non-seminoma GCT and easily detectable in the peripheral blood, have demonstrated to be promising in this endeavor. Large prospective trials are ongoing to define the operating characteristics of these biomarkers and their clinical utility to improve GCT patient management and reduce the error rate deriving from clinical uncertainty, therefore reducing the risk of sub-optimal treatments.
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Affiliation(s)
- Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
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Huang Z, Berg WT. Iatrogenic effects of radical cancer surgery on male fertility. Fertil Steril 2021; 116:625-629. [PMID: 34462097 DOI: 10.1016/j.fertnstert.2021.07.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/23/2021] [Indexed: 12/27/2022]
Abstract
Iatrogenic causes of male infertility can include medications, chemotherapy, radiation, and surgery. In this review, we discuss commonly performed urologic cancer surgeries and nonurologic surgeries that harbor a high risk of iatrogenic infertility. These include radical prostatectomy, radical cystectomy, retroperitoneal lymph node dissection, pelvic colon surgery, and anterior spine surgery. In addition, we review the anatomy and surgical strategies that help to reduce the risks of infertility. With an increase in life expectancy and improvements in fertility preservation, it is important to properly counsel patients about the risks of infertility and provide options for fertility preservation before surgery.
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Affiliation(s)
- Zhenyue Huang
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - William T Berg
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.
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Francolini G, Trodella LE, Marvaso G, Matrone F, Nicosia L, Timon G, Ognibene L, Vinciguerra A, Franzese C, Borghetti P, Arcangeli S. Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario. Int J Clin Oncol 2021; 26:1777-1783. [PMID: 34273014 DOI: 10.1007/s10147-021-01989-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/07/2021] [Indexed: 12/01/2022]
Abstract
Historically, non-seminomatous germ cell tumor (NSGCT) has been considered a radio-resistant disease, excluding radiotherapy (RT) from curative strategies. However, case series exploring the use of radiation treatment in this setting are often outdated, and prospective ongoing studies testing new radiotherapeutic approaches in NSGCT are lacking. Considering that tremendous advances in radiotherapy technology have enabled improved precision in RT delivery as well as dose escalation while decreasing treatment-related morbidity, we overviewed the currently available literature to explore the radiobiological basis, the technical issues, and potential strategies for implementation of RT in the management of this clinical entity. The purpose of the present overview is to provide insight for future research in this unexplored scenario. In summary, the biological rationale for RT use and potential implementation with systemic therapies exist, especially considering the advantage of new technologies, which were unavailable in the era of early literature reports. The NSGCT radioresistance paradigm could be based only on the fact that effective treatment schedules were simply undeliverable with older RT techniques due to toxicity issues, but the availability of actual techniques may prompt further exploration to offer treatment alternatives to these patients. Ongoing trials on this issue are lacking, but potential areas of research are platinum-refractory disease and consolidation therapy for residual masses after PST.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabio Matrone
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Pordenone, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - Giorgia Timon
- Radioterapia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Ognibene
- Radiotherapy Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | - Annamaria Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Radiotherapy and Radiosurgery Department -Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery-University of Milan Bicocca, Milan, Italy
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Hajiran A, Azizi M, Aydin AM, Chakiryan NH, Peyton CC, Boulware DC, Manley BJ, Gilbert SM, Sexton WJ. Retroperitoneal Lymph Node Dissection Versus Surveillance for Adult Early Stage Pure Testicular Teratoma: A Nationwide Analysis. Ann Surg Oncol 2021; 28:3648-3655. [PMID: 33689081 PMCID: PMC9801512 DOI: 10.1245/s10434-021-09696-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Following radical orchiectomy, surveillance and primary retroperitoneal lymph node dissection (RPLND) are acceptable options for the management of early stage pure testicular teratoma in adult patients; however, there is no uniform consensus. The aim of this study was to investigate survival outcomes of adults with early stage pure testicular teratoma based on management strategy. METHODS Data was extracted from the National Cancer Database (NCDB) from testicular cancer patients diagnosed with clinical stage (CS) I pure teratoma (pT1-4N0M0S0) between 2004 and 2014. Kaplan-Meier and Cox regression analyses were used to assess clinical outcomes based on management strategy. RESULTS Of the 61,167 patients diagnosed with testicular cancer, 692 (1.1%) had pure teratoma. Only individuals with CS I disease were considered (n = 237). The median age was 28 (23-35) years. Overall, 43 (18%) patients underwent RPLND and 194 (82%) patients were managed with surveillance. There was an increase in surveillance for CS I teratoma during the study period. Increasing distance from residence to treatment facility was an unadjusted predictor for undergoing primary RPLND (p < 0.001). Median follow-up was 54 months and there was no significant difference in overall survival between CS I teratoma patients managed with RPLND and those managed with surveillance (p = 0.13). CONCLUSIONS There has been a trend toward increasing adoption of surveillance for the management of early stage pure testicular teratoma in adults. Our findings suggest that surveillance provides comparable survival outcomes to primary retroperitoneal lymph node dissection in this setting.
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Affiliation(s)
- Ali Hajiran
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - Mounsif Azizi
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ahmet M Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Nicholas H Chakiryan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles C Peyton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - David C Boulware
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brandon J Manley
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute Center, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Pickersgill NA, Raval NS, Kim EH, Black RG, Du K, Figenshau RS. Post-chemotherapy Laparoscopic Retroperitoneal Lymph Node Dissection for Mixed Malignant Germ Cell Testicular Tumors. Clin Genitourin Cancer 2021; 19:273.e1-273.e5. [PMID: 33139148 DOI: 10.1016/j.clgc.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Retroperitoneal lymph node dissection (RPLND) is performed to treat residual disease following chemotherapy for stage II and III testicular cancer. Significant morbidity can be associated with open RPLND. As such, laparoscopic techniques have been demonstrated to be safe and effective in select cases. Outcomes following post-chemotherapy laparoscopic RPLND for mixed malignant germ cell testicular tumors (MMGCT) are limited in the literature. PATIENTS AND METHODS We performed a retrospective chart review for patients who underwent laparoscopic RPLND at our institution for MMGCT from May 2006 to October 2016. Patient clinical data and perioperative and oncologic outcomes were recorded. RESULTS Twenty-three patients underwent post-chemotherapy laparoscopic RPLND. Thirty-five percent (8/23) underwent bilateral template dissection, whereas 65% (15/23) underwent a modified unilateral template dissection. Robotic assistance was utilized in 22% (5/23) of cases. Bilateral template was inferior to unilateral template RPLND in operative time, estimated blood loss, open conversion rate, length of hospital stay, and complication rate. The mean follow-up was 35.1 months and 43.3 months for the bilateral and unilateral template groups, respectively. The mean lymph node yield and recurrence rate were similar between the 2 cohorts. One recurrence of mature teratoma was noted 67 months after unilateral laparoscopic RPLND. CONCLUSIONS In select patients, laparoscopic RPLND for stage II and III MMGCT is safe and effective in the post-chemotherapy setting. Bilateral template laparoscopic RPLND was associated with inferior perioperative outcomes, but similar oncologic outcomes compared with unilateral template. Patients requiring bilateral template RPLND should be considered for an open approach.
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Affiliation(s)
| | - Neel S Raval
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Eric H Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - River G Black
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Kefu Du
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - R Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO.
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Rosenvilde JJ, Pedersen GL, Bandak M, Lauritsen J, Kreiberg M, Wagner T, Aagaard M, Daugaard G. Oncological outcome and complications of post-chemotherapy retroperitoneal surgery in non-seminomatous germ cell tumours - a systematic review. Acta Oncol 2021; 60:695-703. [PMID: 33819117 DOI: 10.1080/0284186x.2021.1905176] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Post-chemotherapy surgery constitutes an integral part of the management of patients with non-seminomatous germ-cell tumours with a residual mass in the retroperitoneum. Published data on recurrence rates and complications to bilateral retroperitoneal lymph node dissection (RPLND), unilateral template RPLND, and resection of residual mass only according to different surgical techniques (open, laparoscopic, and robotic surgery) were reviewed. MATERIAL AND METHODS PubMed/Medline, Embase, and the Cochrane databases were searched systematically. The risk of bias was assessed with the Newcastle Ottawa Scale. RESULTS In total, 28 studies were included. Eight studies reported on open surgery with the bilateral template, seven on the unilateral template, and three on resection of mass only. Median follow-up was 39, 39, and 70 months, respectively. Recurrences were found in 11, 12, and 14%, respectively. Major complications (Clavien-Dindo III or more) were observed in 18, 8, and 17%, respectively. Two studies reported on laparoscopic bilateral surgery, eight on unilateral, and two on residual mass only. A total of Median follow-up was 52, 29, and 55 months, respectively. Recurrences were found in 0, 1, and 9%, respectively. Major complications were not documented for bilateral but were observed in 4% for unilateral and 0% for resection of tumour only. Four studies on robotic bilateral surgery, three on unilateral and two on resection of tumour only were included. Follow-up was 18, 35, and 30 months, respectively. Recurrences were found in 0, 0, and 2%, respectively. Major complications were observed in 0, 10. and 2%, respectively. CONCLUSIONS When patient selection is made, recurrence rates for the open unilateral template are comparable to the bilateral template. The risk of complications is highest after an open bilateral template. Laparoscopic and robotic surgery should not be used as a standard procedure. More studies are required with larger patient populations and longer follow-up.
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Affiliation(s)
| | - Gyrithe L. Pedersen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikael Aagaard
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours. Sci Rep 2021; 11:10700. [PMID: 34021196 PMCID: PMC8140155 DOI: 10.1038/s41598-021-89823-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/30/2021] [Indexed: 12/26/2022] Open
Abstract
Data on robotic retroperitoneal lymph node dissection (R-RPLND) for metastatic testicular germ cell tumours (mTGCTs) are scarce and the use of R-RPLND itself is still under debate. The aim of our study was to evaluate the indications, feasibility and outcomes of R-RPLND, with special emphasis on differences between primary R-RPLND (pR-RPLND) and post-chemotherapeutic R-RPLND (pcR-RPLND) in mTGCTs. We retrospectively analysed the data of patients who underwent R-RPLND for mTGCT between November 2013 and September 2019 in two centres in Germany. Indications, operative technique, intra- and postoperative complications and oncologic outcome were analysed. Twenty-three mTGCT patients underwent R-RPLND (7 pR-RPLND, 16 pcR-RPLND). For pR-RPLND versus pcR-RPLND, median time of surgery was 243 min [interquartile range (IQR) 123-303] versus 359 min (IQR 202-440, p = 0.154) and median blood loss 100 mL (IQR 50-200) versus 275 mL (IQR 100-775, p = 0.018). Intra- and postoperative complications were more frequent in pcR-RPLND (pcR-RPLND: intra/post: 44%/44%; pR-RPLND: intra/post: 0%/29%). However, these were only statistically significant in the case of intraoperative complications (intra: p = 0.036, post: p = 0.579). Intraoperative complications (n = 7), conversions (n = 4) and transfusions (n = 4) occurred in pcR-RPLND patients only. After a median follow-up of 16.3 months (IQR 7.5-35.0) there were no recurrences or deaths. R-RPLND displays a valuable, minimally invasive treatment option in mTGCT. However, R-RPLND is challenging and pcR-RPLND especially bears a considerable risk of complications. This operation should be limited to patients with an easily accessible residual tumour mass and to surgeons experienced in robotic surgery and TGCT treatment.
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Chovanec M, Lauritsen J, Bandak M, Oing C, Kier GG, Kreiberg M, Rosenvilde J, Wagner T, Bokemeyer C, Daugaard G. Late adverse effects and quality of life in survivors of testicular germ cell tumour. Nat Rev Urol 2021; 18:227-245. [PMID: 33686290 DOI: 10.1038/s41585-021-00440-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
Currently, ~95% of patients with testicular germ cell tumour (TGCT) are cured, resulting in an increasing number of TGCT survivors. Although cured, these men face potential late adverse effects and reduced quality of life. Survivors face a twofold increased risk of second malignant neoplasms after chemotherapy and radiotherapy, with evidence of dose-dependent associations. For survivors managed with surveillance or treated with radiotherapy, the risk of cardiovascular disease (CVD) is comparable to the risk in the general population, whereas treatment with chemotherapy increases the risk of life-threatening CVD, especially during treatment and after 10 years of follow-up. Other adverse effects are organ-related toxicities such as neuropathy and ototoxicity. Pulmonary and renal impairment in patients with TGCT treated with chemotherapy is limited. Survivors of TGCT might experience psychosocial distress including anxiety disorders, fear of cancer recurrence and TGCT-specific issues, such as sexual dysfunction. Late adverse effects can be avoided in most patients with stage I disease if followed on a surveillance programme. However, patients with disseminated disease can experience toxicities associated with radiotherapy and chemotherapy, and/or adverse effects related to surgery for residual disease. The severity of adverse effects increases with dose of both chemotherapy and radiotherapy. This Review discusses the most recent data concerning the late adverse effects of today's standard treatments for TGCT.
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Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoph Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gry Gundgaard Kier
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josephine Rosenvilde
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Raja A, Malik K, Kathiresan N, Radhakrishnan V. Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection (PC RPLND) for Nonseminomatous Germ Cell Tumour: Experience from a Tertiary Cancer Centre. Indian J Surg Oncol 2021; 12:374-377. [PMID: 34295081 DOI: 10.1007/s13193-021-01313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/21/2021] [Indexed: 11/27/2022] Open
Abstract
Postchemotherapy RPLND remains an integral part of management of testicular tumours. Nerve-sparing techniques can minimize the ejaculatory dysfunction due to the procedure. We report our functional and oncological outcomes for nerve-sparing RPLND in postchemotherapy settings. We analysed data from all patients undergoing nerve-sparing PC RPLND from January 1990 to December 2013 at our institute. Antegrade ejaculation and fertility issues were determined by patient history. Nerve sparing was achieved in 30% of patients undergoing PC RPLND. Of the 33 patients who underwent nerve-sparing PC RPLND, 19 (57.8%) had antegrade ejaculation. The mean time to antegrade ejaculation was 6.8 months. After a median follow-up of 75.61 months, 5-year disease-free survival was 98%. Nerve-sparing RPLND can improve functional outcomes without increasing recurrence rates in post chemotherapy setting.
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Affiliation(s)
- Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), No. 38 Sardar Patel Marg, Adyar, Chennai, Tamil Nadu 600036 India
| | - Kanuj Malik
- Department of Surgical Oncology, Cancer Institute (WIA), No. 38 Sardar Patel Marg, Adyar, Chennai, Tamil Nadu 600036 India
| | - N Kathiresan
- Department of Surgical Oncology, Apollo Hospital, Chennai, India
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Torres L, Ramos JG, Varela R, Cabrera M, Orrego PA, Mosquera AV, Vecino SVP. Complicaciones de la linfadenectomía retroperitoneal postquimioterapia en pacientes con tumor germinal de origen testicular: Experiencia de 12 años en un centro de referencia en Colombia. Rev Urol 2021. [DOI: 10.1055/s-0040-1721327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Resumen
Objetivo El objetivo de este estudio, fue describir las complicaciones intraoperatorias y postoperatorias, así como la necesidad de cirugías concomitantes en la linfadenectomía retroperitoneal postquimioterapia en un centro de referencia de manejo de cáncer.
Métodos Se recolectaron datos de una cohorte retrospectiva de pacientes con diagnóstico de tumor germinal de origen testicular que hubiesen recibido quimioterapia y en quienes se documentó tumor residual retroperitoneal y fueron sometidos a LRP-PC durante 12 años en un centro de referencia de manejo de cáncer.
Resultados Se practicó LRP-PC a 64 pacientes. La edad promedio al momento de la cirugía fue 28,1 años (18-47 años). El tamaño promedio de la masa retroperitoneal post quimioterapia fue 6,7 (1–28 cm). La estancia hospitalaria promedio fue 7,9 días (rango 1-99 días), la tasa de cirugías adicionales fue del 20%. La tasa de complicaciones mayores fue de 7,8%. Tener seminoma en la histología testicular inicial se asoció con un mayor sangrado y el tamaño de la masa retroperitoneal residual se asoció con la necesidad de cirugías concomitantes.
Conclusiones La LRP-PC es una cirugía de alto nivel de complejidad que se asocia a complicaciones mayores y a la necesidad de cirugías concomitantes. Esta cohorte de pacientes muestra desenlaces similares a los descritos en la literatura, recalcando el hecho de que esta cirugía, debería ser realizada en centros de referencia de manejo del cáncer.
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Affiliation(s)
- Lynda Torres
- Pontificia Universidad Javeriana, Centro Policlínico Olaya, Bogotá, Colombia
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Makovník M, Rejleková K, Uhrin I, Mego M, Chovanec M. Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors. Front Oncol 2021; 10:587523. [PMID: 33585206 PMCID: PMC7874236 DOI: 10.3389/fonc.2020.587523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Testicular germ cell tumors (GCTs) are malignancies with a unique biology, pathology, clinical appearance, and excellent outcomes. A correct radiographic assessment of GCTs is extremely important for the clinical management in several typical scenarios. Advancements in the field of diagnostic medicine bring an increasing number of sophisticated imaging methods to increase the performance of imaging studies. The conventional computed tomography (CT) remains the mainstay of diagnostic imaging in the management of GCTs. While certain improvements in the sensitivity and specificity are suggested with magnetic resonance (MR) imaging with lymphotrophic nanoparticles in evaluating retroperitoneal lymph nodes during the staging procedure, further exploration in larger prospective studies is needed. A common diagnostic dilemma is assessing the post-chemotherapy residual disease in GCTs. Several studies have consistently shown advantages in the utility of positron emission tomography (PET) scanning in post-chemotherapy residual retroperitoneal lymph nodes in patients with seminoma, but not with non-seminoma. Recommendations suggest that seminoma patients with a residual disease in the retroperitoneum larger than 3 cm should be subjected for PET scanning with 18-fluorodeoxyglucose. Relatively high sensitivity, specificity and a negative predictive value (80-95%) may guide clinical decision to spare these patients of high morbidity of an unnecessary surgery. However, a positive predictive value of around 50% renders PET scanning difficult to interpret in the case of positive finding. These patients often require extremely difficult surgical procedures with the high risk of post-operative morbidity. Therefore, seminoma patients with PET positive residual masses larger than 3 cm still remain a serious challenge in the decision making of nuclear medicine specialist, oncologists, and urologic surgeons. In this article, we aim to summarize data on controversial dilemmas in staging procedures, active surveillance, and post-chemotherapy assessment of GCTs based on the available published literature.
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Affiliation(s)
- Marek Makovník
- Radiology Department, National Cancer Institute, Bratislava, Slovakia
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Katarína Rejleková
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ivan Uhrin
- Radiology Department, National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
- Translational Research Unit, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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Murez T, Fléchon A, Savoie PH, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. [French ccAFU guidelines - update 2020-2022: testicular germ cell tumors]. Prog Urol 2020; 30:S280-S313. [PMID: 33349427 DOI: 10.1016/s1166-7087(20)30754-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE - To update French guidelines concerning testicular germ cell cancer. MATERIALS AND METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated. RESULTS - Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm. CONCLUSIONS - A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).
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Affiliation(s)
- T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Torres L, Ramos JG, Varela R, Godoy F, Orrego PA, Mosquera A, Vecino SVP. Factores asociados a la histología de masa residual retroperitoneal post quimioterapia en tumor testicular de células germinales. Rev Urol 2020. [DOI: 10.1055/s-0040-1721357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Resumen
Objetivo El objetivo de este estudio es describir las características y factores relacionados con la histología de la masa residual postquimioterapia en pacientes con tumor de células germinales de origen testicular sometidos a linfadenectomía retroperitoneal durante 12 años de seguimiento.
Métodos Retrospectivamente se recolectaron datos clínicos, quirúrgicos y patológicos de la historia clínica de los pacientes en un centro de referencia de manejo de cáncer durante un periodo de 12 años. Se estimó la asociación entre los datos recolectados con la histología del tumor residual post quimioterapia.
Resultados Se incluyeron 64 pacientes, la edad promedio fue 28.1 años, el tamaño promedio de masa residual fue de 6.7 cm. La histología de la masa residual fue teratoma en 60.9%, necrosis 26.5% y tumor viable 12.5%. El grupo pronóstico tiene asociación con la histología de la masa retroperitoneal. Las masas con histología de necrosis tuvieron menor tamaño con media 6.5 cm mientras que otras histologías tuvieron tamaño promedio de la masa residual de 10.4 cm.
Conclusiones La LNDRP-PC es el estándar de tratamiento en masas residuales retroperitoneales después de quimioterapia y puede generar sobre-tratamiento hasta en 50% de los casos. El teratoma en la histología testicular está relacionado mayor tamaño de la masa residual retroperitoneal. Las características histológicas de la masa residual son comparables con otras series.
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Affiliation(s)
- Lynda Torres
- Médica Uróloga. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jose Gustavo Ramos
- Médico Urólogo, Urología Oncológica, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Rodolfo Varela
- Médico Urólogo, Urología Oncológica, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Fabian Godoy
- Médico Urólogo, Urología Oncológica, Instituto Nacional de Cancerología, Bogotá, Colombia
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Mian BM, Siddiqui S, Ahmad AE. Management of urologic cancers during the pandemic and potential impact of treatment deferrals on outcomes. Urol Oncol 2020; 39:258-267. [PMID: 33129674 PMCID: PMC7598541 DOI: 10.1016/j.urolonc.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 01/03/2023]
Abstract
The COVID-19 pandemic-related constraints on healthcare access have raised concerns about adverse outcomes from delayed treatment, including the risk of cancer progression and other complications. Further, concerns were raised about a potentially significant backlog of patients in need of cancer care due to the pandemic-related delays in healthcare, further exacerbating any potential adverse outcomes. Delayed access to surgery is particularly relevant to urologic oncology since one-third of new cancers in men (20% overall) arise from the genitourinary (GU) tract and surgery is often the primary treatment. Herein, we summarize the prepandemic literature on deferred surgery for GU cancers and risk of disease progression. The aforementioned data on delayed surgery were gathered in the context of systemic delays present in certain healthcare systems, or occasionally, due to planned deferral in suboptimal surgical candidates. These data provide indirect, but sufficient insight to develop triage schemas for prioritization of uro-oncological cases. Herein, we outline the extent to which the pandemic-related triage guidelines had influenced urologic practice in various regions. To study the adverse outcomes in the pandemic-era, a survey of urologic oncologists was conducted regarding modifications in their initial management of urologic cancers and any delay-related adverse outcomes. While the adverse effects directly from COVID-19 related delays will become apparent in the coming years, the results showing short-term outcomes are quite instructive. Since cancer care was assigned a higher priority at most centers, this strategy may have avoided significant delays in care and limited the anticipated negative impact of pandemic-related constraints.
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Affiliation(s)
- Badar M Mian
- Division of Urology, Albany Medical Center, Albany NY.
| | - Sana Siddiqui
- Division of Urology, Albany Medical Center, Albany NY
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