Nerve-Preserving Bilateral Retroperitoneal Lymphadenectomy: Anatomical Study and Operative Approach

Colleselli, K.; Poisel, S.; Schachtner, W.; Bartsch, Georg

doi:10.1016/s0022-5347(17)39435-1

Cited by 73 publications

(39 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This particular recurrence was in a patient with stage IIC disease after unilateral dissection using the template of Weissbach and Boedefeld [6], which was obviously too small. This recurrence could have been avoided if the dissection had been within the boundaries proposed by Colleselli et al [10]. The present study yielded an excellent cure rate of 99% and a very low recurrence rate (2.9%) after a long follow-up (median 102 months), and low long-term morbidity (anejaculation in only 6% of patients), thus supporting the concept of a restricted template in selected patients.…”

Section: Discussionsupporting

confidence: 83%

“…However, on closer inspection of the data for stage B1 and B2 patients in the two mapping studies, there was significant metastatic spread outside the modified template proposed by Donohue et al [15] or Weissbach and Boedefeld [6] (up to ≈ 30% depending on the study) also in low-volume retroperitoneal stage II disease. If the template proposed by Colleselli et al [10] (sparing the contralateral side below the IMA only, Fig. 1) had been used, there would have been significantly fewer missed positive nodes according to the mapping studies presented in [6,17], only up to 14.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…As an alternative, several authors proposed modified template dissections [6,10,15]. The use of modified templates originally developed for stage I disease after chemotherapy is controversial and is often considered inappropriate in patients with advanced disease [1,16].…”

Section: Discussionmentioning

confidence: 99%

“…What makes the published debate problematic is that the proposed templates (especially those proposed in [6], [10] and [15]) are not congruent. Donohue et al [15] presented two different types of modified templates (modified, modified nerve-sparing type).…”

Section: Discussionmentioning

confidence: 99%

“…For left-sided tumours the template comprised the area between the left ureter, left renal vessels, midline of the aorta, and left iliac artery; for right-sided tumours RPLND was within the boundaries of the right ureter, right renal vessels, midline of the aorta, and the right iliac artery, including the retrocaval nodes; 24 patients (stage IIC in eight, IIB in 13, and tumour marker-positive IIA in three) had an open modified template dissection [9] according to the boundaries described by Colleselli et al [10] (Fig. 1), in which the contralateral retroperitoneal area below the IMA are spared.…”

Section: B J U I N T E R N a T I O N A Lmentioning

confidence: 99%

See 4 more Smart Citations

Retroperitoneal lymph node dissection after chemotherapy for germ cell tumours: is a full bilateral template always necessary?

Steiner¹,

Peschel²,

Bartsch³

2008

BJU International

View full text Add to dashboard Cite

OBJECTIVETo evaluate the long‐term oncological outcome in selected patients treated for nonseminomatous germ cell tumours (NSGCT) with a retroperitoneal lymph node dissection after chemotherapy (pcRPLND) and not using the full bilateral template.PATIENTS AND METHODSFrom 1988 to 2005, 102 patients with retroperitoneal stage II NSGCT, who at initial presentation had metastases in the primary retroperitoneal site only, had pcRPLND within a restricted template, whether computed tomography showed complete or incomplete remission. In all, 78 patients had a unilateral template dissection and 24 an open modified template dissection.RESULTSOf the 102 patients, 30 had stage IIC, 63 IIB, and nine tumour marker‐positive stage IIA disease. Active tumour was found in two RPLND specimens; mature teratoma in 46 of the 102 patients, and necrosis/fibrosis in 54. Antegrade ejaculation was preserved in all 78 patients who had unilateral RPLND and in 18 of 24 who had a modified RPLND (overall antegrade ejaculation rate 94%). During a median follow‐up of 102 months there were only three recurrences, two outside the retroperitoneum and one in the retroperitoneum. Only the latter was retrocaval, above the level of the inferior mesenteric artery within the boundaries of a full bilateral RPLND. This patient had had left unilateral template dissection after chemotherapy for IIC disease which was restricted to the para‐aortic nodes.CONCLUSIONIn a selected group of patients with stage II NSGCT, pcRPLND within the modified template might be oncologically efficient and allow ejaculation to be preserved.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: B J U I N T E R N a T I O N A Lmentioning

confidence: 99%

See 3 more Smart Citations

Retroperitoneal lymph node dissection after chemotherapy for germ cell tumours: is a full bilateral template always necessary?

Steiner¹,

Peschel²,

Bartsch³

2008

BJU International

View full text Add to dashboard Cite

show abstract

Retroperitoneal surgery in patients with nonseminomatous testicular cancer and minimal residual tumor

Qvist

Fosså

Ous

et al. 1992

Journal of Surgical Oncology

View full text Add to dashboard Cite

In the period 1980-1991, 78 patients with advanced nonseminomatous testicular cancer underwent retroperitoneal lymphadenectomy for post-chemotherapy residual masses less than 2 cm. To decrease the frequency of "dry ejaculation" in these patients with no or limited residual disease, the extent of dissection was reduced during the period, with bilateral dissections (49 cases, 1980-1986) being initially replaced by unilateral procedures (19 cases, 1983-1990) and subsequently by nerve-sparing techniques (10 cases, 1990-1991). As expected, a higher total number of lymph nodes was found in the retroperitoneal specimens after bilateral (44 (13-100)) than after unilateral (21 (7-35)) and nerve-sparing (18 (7-60)) procedures. The number of lymph nodes with pathological changes was low, with 3 (1-16) after bilateral, 2 (1-9) after unilateral, and 2 (1-4) after nerve-sparing operations. Histological examination revealed only necrosis/fibrosis in 65% of the patients, elements of mature teratoma in 28%, and remnants of viable malignant tumor in 6%. There were no major postoperative complications. "Dry ejaculation" was reported by 84% of the patients with bilateral operations, but was generally avoided after the unilateral (16%) and nerve-sparing (nil) procedures. After a mean follow-up of 83 (5-138) months, 6 patients have developed a recurrence, only one of them primarily in the retroperitoneal space. It is concluded that in patients with minimal residual retroperitoneal tumor, postchemotherapy lymphadenectomy using a unilateral or nerve-sparing technique seems to offer an effective therapeutic alternative with acceptable postoperative morbidity and preserved ejaculation.

show abstract

Laparoscopic Retroperitoneal Lymph Node Dissection: Extraperitoneal Approach

Satoh

Ito

Arai

Recent Advances in Endourology

View full text Add to dashboard Cite

Nerve-Preserving Bilateral Retroperitoneal Lymphadenectomy: Anatomical Study and Operative Approach

Cited by 73 publications

References 9 publications

Retroperitoneal lymph node dissection after chemotherapy for germ cell tumours: is a full bilateral template always necessary?

Retroperitoneal lymph node dissection after chemotherapy for germ cell tumours: is a full bilateral template always necessary?

Retroperitoneal surgery in patients with nonseminomatous testicular cancer and minimal residual tumor

Laparoscopic Retroperitoneal Lymph Node Dissection: Extraperitoneal Approach

Contact Info

Product

Resources

About