Nerve-Sparing Retroperitoneal Lymphadenectomy with Preservation of Ejaculation

Donohue, John P.; Foster, Richard S.; Rowland, Randall G.; Bihrle, Richard; Jones, Jeffrey A.; Geier, George

doi:10.1016/s0022-5347(17)39434-x

Cited by 294 publications

(107 citation statements)

References 16 publications

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“…In metastatic patients, post-chemotherapy RPLND was initially performed bilaterally (Whitmore Jr, 1979). From 1986, ipsilateral unilateral template RPLND only was introduced, refined by nerve-sparing techniques, whenever possible, after 1990 (Donohue et al, 1990;Jacobsen et al, 1999).…”

Section: Treatmentmentioning

confidence: 99%

Late recurrences of germ cell malignancies: a population-based experience over three decades

et al. 2006

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The purpose of this study was to explore the incidence of late relapse in patients with malignant germ cell tumour (MGCT) in a population-based series, with emphasis on the mode of detection, survival, and the relevance of histological findings. The clinical records from a population-based cohort of patients with seminoma (n ¼ 1123) or non-seminoma (n ¼ 826) were evaluated for late relapses. Twenty-five patients developed a late relapse. The cumulative 10-year incidence rate was 1.3%. All 10 seminoma patients, but only eight of 15 non-seminoma patients relapsed with vital malignant tumour (P ¼ 0.02). Teratoma or necrosis was found in seven of nine primarily chemotherapy-treated non-seminoma patients with normal tumour markers at late relapse. Six of nine patients operated with limited retroperitoneal lymph node dissection as part of the primary treatment had relapsed retroperitoneally outside the original operation field. The 10-year cause-specific survival was 68% in all patients, 50% in patients relapsing with vital malignant tumour and 100% in those with teratoma/ necrosis before or after salvage chemotherapy. The 10-year incidence rate of late relapses of 1.3% might reflect the true incidence rate in a population-based cohort of MGCT patients, with cure in at least half of them.

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Section: Treatmentmentioning

confidence: 99%

Late recurrences of germ cell malignancies: a population-based experience over three decades

et al. 2006

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“…Donohue et al (1990) attempted to identify the sympathetic fibres emerging from the thoraco-lumbal ganglia on both sides and to preserve their continuity by thorough dissection of the retroperitoneal lymphatic tissue surrounding the nerves. At least 90% of patients operated on with this technique preserved antegrade ejaculation.…”

Section: Discussionmentioning

confidence: 99%

“…From 1985From to 1988, resection of retroperitoneal tissue was confined to the ipsilateral side of the aortic midline in patients with retroperitoneal tumour disease confined to one template. During nerve-sparing RPLND the sympathetic nerve fibres were carefully dissected out, identified and preserved, at least on one side (Donohue et al, 1990). Unilateral template nerve-sparing RPLND (Figure 1) was introduced in 1992 by one of the authors (SO) for patients with tumours confined to the ipsilateral template.…”

Section: Modified Bilateral Template Rplndmentioning

confidence: 99%

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Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection

et al. 1999

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SummaryThe purpose of this study was to evaluate fertility after different types of post-chemotherapy retroperitoneal lymph node dissection (RPLND). During 1980During -1994 patients with metastatic testicular cancer underwent post-chemotherapy RPLND with a gradual shift from modified bilateral template RPLND to nerve-sparing RPLND. Modified bilateral template RPLND was done in 92% of the patients operated during 1980-1984 as compared to 16% during 1989-1994. Pre-and post-treatment fertility was assessed by microscopic sperm analysis, determination of serum FSH and information on ejaculation and paternity. There was no significant difference of the survival rates between the three treatment periods. Antegrade ejaculation was preserved in 11% of the patients after modified bilateral template RPLND as compared to 89% after the nerve-sparing operation technique. The median ejaculatory volume decreased post-operatively, serum FSH increased and sperm density remained unchanged. Fifty-six patients attempted fatherhood after their treatment, and 27 fathered at least one child after an observation-time of 55 months, nine of them by assisted fertilization. Patients with initially advanced testicular cancer but limited residual retroperitoneal masses after induction chemotherapy can safely undergo limited post-chemotherapy RPLND as a part of multimodality treatment. After nerve-sparing RPLND antegrade ejaculation is preserved in 89% of the patients though the ejaculatory volume decreases after RPLND. Post-treatment fatherhood can be achieved in at least 50% of the patients attempting paternity.

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“…Subsequent RP relapse is rare, and abdominal imaging can be restricted to one baseline CT a few months after surgery. With the introduction of nerve-sparing technique along with various modified templates, antegrade ejaculation rates of 90-100% have been reported, with significantly reduced morbidity and virtually unknown mortality [64][65][66]. It is important to be aware of slowgrowing retroperitoneal teratomas after primary chemotherapy [67].…”

Section: Retroperitoneal Lymph Node Dissectionmentioning

confidence: 99%

Current Concepts in Management of Stage I NSGCT

Ahluwalia

Gautam

2016

Indian J Surg Oncol

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While about 50% of non-seminomatous germ cell tumors of the testes present as clinical stage I (CSI), further management of these patients continues to be mired in controversy. Active surveillance is a frontline option for low-risk CS I patients and according to some, even the high-risk ones with high embryonal carcinoma (ECA) component and vascular invasion (VI). However, it carries the disadvantage of long-term surveillance, the need for prolonged chemotherapy in case of recurrence and the possibility of secondary malignancies due to radiation exposure from frequent CT scans. One or two cycles of BEP chemotherapy is a popular alternative to active surveillance which carries a very low relapse rate, but valid concerns about overtreatment of a majority of patients, with the attendant chemotherapy-related toxicity exist. Retroperitoneal lymph node dissection has been used as a means of avoiding chemotherapy, especially in high-risk patients, but carries the disadvantage of a high surgical morbidity and complications. As with any major surgical procedure, the best results are dependent on the experience and skill of the individual surgeon.

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Nerve-Sparing Retroperitoneal Lymphadenectomy with Preservation of Ejaculation

Cited by 294 publications

References 16 publications

Late recurrences of germ cell malignancies: a population-based experience over three decades

Late recurrences of germ cell malignancies: a population-based experience over three decades

Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection

Current Concepts in Management of Stage I NSGCT

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