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McClintock G, Goolam AS, Perera D, Downey R, Leslie S, Grimison P, Woo H, Ferguson P, Ahmadi N. Robotic-assisted retroperitoneal lymph node dissection for stage II testicular cancer. Asian J Urol 2024; 11:121-127. [PMID: 38312811 PMCID: PMC10837656 DOI: 10.1016/j.ajur.2022.03.010] [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: 07/25/2021] [Revised: 01/30/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer. Methods We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution. Data were collected on patient and tumour characteristics, intraoperative and postoperative parameters, and functional and oncological outcomes. Descriptive statistics are presented. Results Nineteen patients were identified; 18 (94.7%) completed the procedure robotically and one was converted to open surgery; 78.9% of patients had stage ≥IIB and 12 (63.2%) patients had undergone prior chemotherapy. The median operative time was 300 (interquartile range [IQR] 240-315) min. Median blood loss was 100 (IQR 50-175) mL. Median length of stay was 2 (range 1-11) days. All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3. The median lymph node yield was 40.5 (IQR 38-51) nodes. All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function. One patient had a Clavien-Dindo III complication (chylous ascites requiring drainage). At a median follow-up of 22.3 (IQR 16.3-24.9) months, one patient developed retroperitoneal recurrence, which was successfully treated with second-line chemotherapy; no other patients have had recurrences. Conclusion Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients, offering low morbidity. Early oncological outcomes are promising. Larger cohorts and longer follow-ups are required to validate our institution's findings.
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Affiliation(s)
- George McClintock
- Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ahmed S. Goolam
- Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Don Perera
- Department of Anaesthesia, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ryan Downey
- Department of Anaesthesia, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Scott Leslie
- Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, 2006, Australia
| | - Peter Grimison
- The University of Sydney, Sydney, NSW, 2006, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Henry Woo
- Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, 2006, Australia
| | | | - Nariman Ahmadi
- Department of Urology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
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Dieckmann KP, Radtke A, Geczi L, Matthies C, Anheuser P, Eckardt U, Sommer J, Zengerling F, Trenti E, Pichler R, Belz H, Zastrow S, Winter A, Melchior S, Hammel J, Kranz J, Bolten M, Krege S, Haben B, Loidl W, Ruf CG, Heinzelbecker J, Heidenreich A, Cremers JF, Oing C, Hermanns T, Fankhauser CD, Gillessen S, Reichegger H, Cathomas R, Pichler M, Hentrich M, Eredics K, Lorch A, Wülfing C, Peine S, Wosniok W, Bokemeyer C, Belge G. Serum Levels of MicroRNA-371a-3p (M371 Test) as a New Biomarker of Testicular Germ Cell Tumors: Results of a Prospective Multicentric Study. J Clin Oncol 2019; 37:1412-1423. [PMID: 30875280 PMCID: PMC6544462 DOI: 10.1200/jco.18.01480] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Previous studies suggested that serum levels of microRNA (miR)-371a-3p (so-called M371 test) have a much higher sensitivity and specificity than the classic markers of testicular germ cell tumors (GCTs) and are applicable toward both seminoma and nonseminoma. We sought to confirm the usefulness of this test as a novel biomarker for GCT. PATIENTS AND METHODS In a prospective, multicentric study, serum samples of 616 patients with testicular GCTs and 258 male controls were examined for serum levels of miRNA-371a-3p (miR levels) by quantitative polymerase chain reaction. The GCT population encompassed 359 patients with seminoma and 257 with nonseminoma; 371 had clinical stage I disease, 201 had systemic disease, and 46 had relapses. Paired measurements before and after orchiectomy were performed in 424 patients; 118 with systemic disease had serial measurements during treatment. miR levels were compared with those of β-human chorionic gonadotropin, α-fetoprotein, and lactate dehydrogenase. RESULTS For the primary diagnosis of GCT, the M371 test showed a sensitivity of 90.1%, a specificity of 94.0%, an area under the curve of 0.966 upon receiver operating characteristic analysis, and a positive predictive value of 97.2%. α-Fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase had sensitivities of less than 50% in seminoma and slightly higher sensitivities in nonseminomas. miR levels were significantly associated with clinical stage, primary tumor size, and response to treatment. Relapses had elevated miR levels that subsequently dropped to normal upon remission. Teratoma did not express miR-371a-3p. CONCLUSION The M371 test outperforms the classic markers of GCT with both a sensitivity and a specificity greater than 90%. All histologic subgroups, except teratoma, express this marker. The test could be considered for clinical implementation after further validation.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Asklepios Klinik Altona, Hamburg, Germany
- Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | | | - Lajos Geczi
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | | | | | | | | | | | - Stefan Zastrow
- Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | | | | | | | | | - Susanne Krege
- Klinikum Essen-Mitte Huyssenstiftung, Essen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anja Lorch
- Urologische Universitätsklinik der Heinrich Heine Universität, Düsseldorf, Germany
| | | | - Sven Peine
- Universitätsklinikum Eppendorf, Hamburg, Germany
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Masterson TA, Cary C, Rice KR, Foster RS. The Evolution and Technique of Nerve-Sparing Retroperitoneal Lymphadenectomy. Urol Clin North Am 2015. [PMID: 26216818 DOI: 10.1016/j.ucl.2015.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The evolution of retroperitoneal lymph node dissection technique and associated template modifications for nonseminomatous germ cell tumors have resulted in significant improvement in the long-term morbidity. Through the preservation of sympathetic nerves via exclusion from or prospective identification within the boundaries of resection, maintenance and recovery of antegrade ejaculation are achieved. Nerve-sparing strategies in early-stage disease are feasible in most patients. Postchemotherapy, select patients can be considered for nerve preservation. This article describes the anatomic and physiologic basis for, indications and technical aspects of, and functional and oncologic outcomes reported after nerve-sparing retroperitoneal lymphadenectomy in testicular cancer.
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Affiliation(s)
- Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA.
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA
| | - Kevin R Rice
- Urologic Surgery, Walter Reed National Military Medical Center, 8901 Rockville Road, Bethesda, MD 20889, USA
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, 535 North Barnhill Drive, Suite 420, Indianapolis, IN 46202, USA
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Pedrosa JA, Masterson TA, Rice KR, Bihrle R, Beck SDW, Foster RS. Reoperative retroperitoneal lymph node dissection for metastatic germ cell tumors: analysis of local recurrence and predictors of survival. J Urol 2014; 191:1777-82. [PMID: 24518787 DOI: 10.1016/j.juro.2014.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE While reoperative retroperitoneal lymph node dissection results in durable long-term survival, outcomes are comparatively worse than in patients who undergo initial adequate resection. We identified predictors of cancer specific survival and correlated technical aspects of initial resection to local recurrence in patients treated with repeat retroperitoneal lymph node dissection. MATERIALS AND METHODS We reviewed subsequent data on 203 patients treated with reoperation for recurrent retroperitoneal germ cell tumor after initial retroperitoneal lymph node dissection with local relapse. We used multivariate Cox proportion hazard models for cancer specific survival and multivariate logistic regression for local recurrence. RESULTS The only 2 factors associated with local recurrence at lymph node dissection were incomplete lumbar vessel division at initial resection (p<0.01) and teratoma histology in the reoperative pathology specimen (p=0.01). Median followup was 73 months. Initial survival analysis including preoperative variables indicated that active cancer at initial operation (p=0.04), increased serum tumor markers (p=0.02), M1b stage (p<0.01) and salvage chemotherapy (p=0.01) were independent predictors of worse cancer specific survival. After introducing the final pathological data from reoperation into the final multivariate model only active cancer at reoperation (p<0.01), M1b stage (p=0.01) and salvage chemotherapy before reoperation (p=0.02) retained the association with worse oncologic outcomes. CONCLUSIONS Tumor biology and inadequate surgical technique (incomplete lumbar ligation) are associated with local recurrence after initial retroperitoneal lymph node dissection. Decreased cancer specific survival is expected in this population, mostly driven by active cancer in the final pathology specimen.
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Affiliation(s)
- Jose A Pedrosa
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kevin R Rice
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen D W Beck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Mueller J, Schnoeller T, Zengerling F, Waalkes S, Ghazal AA, Jentzmik F, Schrader M, Schrader AJ. Meta-Analysis to Determine the Diagnostic Value of 2-<sup>18</sup>Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Assessing Residual Tumors after Systemic Therapy for Metastatic Seminoma. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/oju.2011.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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