Nerve Sparing Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Testicular Cancer

Coogan, Christopher L.; Hejase, Mohamed J.; Wahle, Gregory R.; Foster, Richard S.; Rowland, Randall G.; Bihrle, Richard; Donohue, John P.

doi:10.1016/s0022-5347(01)65476-4

Cited by 93 publications

(25 citation statements)

References 15 publications

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“…20 In the current study, we found that 79% of patients recovered antegrade ejaculation following bilateral nerve-sparing PC-RPLND. With bilateral nerve-sparing PC-RPLND, risk of late recurrence is minimized and ejaculatory recovery is maximized.…”

Section: Discussionsupporting

confidence: 48%

Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

Pettus¹,

Carver²,

Masterson³

et al. 2009

Urology

119

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Purpose We evaluated clinical parameters associated with recovery of ejaculation following nerve-sparing post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for non-seminomatous germ cell tumor. Methods We queried our institutional database for all patients who underwent nerve-sparing PC-RPLND between 1995 and 2005 using a bilateral template. Nerve-sparing was carried out whenever technically feasible and oncologically prudent. Antegrade ejaculation was defined as any seminal fluid expulsion and was determined by patient report. We evaluated recovery of antegrade ejaculation based on clinical and pathologic parameters and fit a logistic regression model to determine which pre-operative variables are associated with antegrade ejaculation. Results A total of 341 patients had PC-RPLND during the study period, 136 (40%) with nerve sparing techniques. Post-operative antegrade ejaculation was reported by 107/136 (79%) of patients with information available. On the multivariable analysis, a right-sided primary testicular tumor (OR 0.4, 95% CI: 0.1, 1.0, p=0.044) and residual masses ≥5 cm (OR 0.1, 95% CI: 0.0, 0.7, p=0.020) were associated with retrograde ejaculation. However, 40/54 (74%) with right-sided primary tumors and 4/9 (44%) with mass ≥5 cm reported antegrade ejaculation. The 5-year relapse free survival was 98% with a median follow up of 39 months (IQR 19, 66). Conclusions Nerve-sparing PC-RPLND is associated with excellent functional return of antegrade ejaculation, is feasible in select patients with bulky disease, and has excellent oncologic outcomes.

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Section: Discussionsupporting

confidence: 48%

Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

Pettus¹,

Carver²,

Masterson³

et al. 2009

Urology

119

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“…Being encouraged with the result, an indication of NS‐RPLND was extended to the advanced stage as PC‐RPLND 64 . Some reports showed that 80% of cases with unilateral or bilateral NS‐RPLND maintained normal ejaculation with a relapse rate of 10% 65,66 . Our experience also clarified the safety and good outcome of NS‐PC‐RPLND; with a relapse rate of 1.9% (2/78) at a median follow‐up of 42 months, and preservation of antegrade ejaculation in 83.1% of cases 67 …”

Section: Extent Of Rplnd and Nerve Sparing Methodssupporting

confidence: 54%

Recent strategy for the management of advanced testicular cancer

Nakamura

Miki

2010

Int J of Urology

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Testicular cancer is the most common cancer in young men and the cure rate has been approximately 80% since the introduction of cisplatin in the 1970s. BEP therapy (including bleomycin, etoposide and cisplatin) has become a standard induction therapy instead of PVB therapy (cisplatin, vinblastin and bleomycin). However, the patients with incomplete responses to cisplatin-based first-line therapy or with relapsed disease have an extremely poor prognosis. For such difficult-to-treat patients, there are some proposed treatment options such as ifosfamide-containing salvage chemotherapy or high-dose chemotherapy (HDCT). HDCT with bone marrow rescue has been carried out as salvage or induction chemotherapy. However, a randomized control trial did not show the superiority to conventional first line therapy or salvage therapy. Therefore, a new anticancer agent was tested for cisplatin-refractory or resistant testicular cancer. The development of combination therapy with new anticancer agents such as paclitaxel and irinotecan seems to be effective for these patients. TIP therapy including paclitaxel, ifosfamide and cisplatin would be a standard second line therapy for the patients with BEP failure. Residual tumor resection including retroperitoneal lymph node dissection integrated with induction and salvage chemotherapy still remains to play an important role to achieving a cure for advanced testicular cancer because there is no modality to predict residual viable cancer cells or teratoma element in the residual tumors. In the present review, we discuss and focus on the recent treatment strategy of advanced testicular cancer.

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“…Furthermore, although nerve-sparing procedures are feasible in the post-chemotherapy setting[18], in our hands it appears to be more difficult in the presence of fibrosis in residual masses. These two findings represent the dilemma that every surgeon faces when offering PC-RPLND.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

et al. 2010

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BackgroundRetroperitoneal lymph node dissection has been advocated for the management of post-chemotherapy (PC-RPLND) residual masses of non-seminomatous germ cell tumors of the testis (NSGCT). There remains some debate as to the clinical benefit and associated morbidity. Our objective was to report our experience with PC-RPLND in NSGCT.MethodsWe have reviewed the clinical, pathologic and surgical parameters associated with PC-RPLND in a single institution. Between 1994 and 2008, three surgeons operated 73 patients with residual masses after cisplatin-based chemotherapy for a metastatic testicular cancer. Patients needed to have normal postchemotherapy serum tumor markers, no prior surgical attempts to resect retroperitoneal masses and resectable retroperitoneal tumor mass at surgery to be included in this analysisResultsMean age was 30.4 years old. Fifty-three percent had mixed germ cell tumors. The mean size of retroperitoneal metastasis was 6.3 and 4.0 cm, before and post-chemotherapy, respectively. In 56% of patients, the surgeon was able to perform a nerve sparing procedure. The overall complication rate was 27.4% and no patient died due to surgical complications. The pathologic review showed presence of fibrosis/necrosis, teratoma and viable tumor (non-teratoma) in 27 (37.0%), 30 (41.1%) and 16 (21.9%) patients, respectively. The subgroups presenting fibrosis and large tumors were more likely to have a surgical complication and had less nerve sparing procedures.ConclusionPC-RPLND is a relatively safe procedure. The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.

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Nerve Sparing Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Testicular Cancer

Cited by 93 publications

References 15 publications

Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

Preservation of Ejaculation in Patients Undergoing Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer

Recent strategy for the management of advanced testicular cancer

Retroperitoneal lymph node dissection for residual masses after chemotherapyin nonseminomatous germ cell testicular tumor

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