Retroperitoneal lymph node dissection for metastatic germ cell tumours

Abstract

Testicular germ cell tumours are the most common malignancies in men aged 15-40 years.1 There has been an increased incidence over the past few decades in the UK, 2,3 US 4 and other Caucasian populations. 5 Although the aetiology is unknown, developmental urogenital abnormalities, 6 undescended testes and inguinal hernias have all been associated with higher rates, 7 with sedentary lifestyle, early puberty and genetics also implicated as risk factors. 8-10The British Testicular Tumour Panel and Registry classifies malignant testicular germ cell tumours into two main histological groups: seminomas and teratomas. 11Para-aortic lymph nodes are the most common sites of metastatic disease.Along with the tumour pathology and clinical stage, preoperative staging investigations inform the choice of further treatment, which may be surveillance, chemotherapy or radiotherapy.12 Chemotherapy is usually recommended for those with evidence of metastatic disease while surgical resection is considered for patients with significant residual masses, particularly in the para-aortic region.Surgery is most likely to play a role in improving the outcome of treatment by resecting residual masses in intermediate and poor prognosis patients who are in remission following chemotherapy.Retroperitoneal lymph node dissection (RPLND) is the most common form of surgery required 13 and national guidance recommends that the treatment of patients with advanced disease or recurrence should be carried out in specialised centres.14 In the North Trent Cancer Network (NTCN), vascular surgeons have been members of the germ cell multidisciplinary team and patients requiring RPLND for metastatic testicular cancer have been treated by the vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours. MethodsAll patients diagnosed with testicular germ cell tumour in the NTCN between 1990 and 2009 were entered into a germ cell database. Patients referred to the vascular service for RPLND were identified through this database. The main indications for surgical referral were a residual para-aortic mass of >1-2cm after chemotherapy or as part of the treat- ABSTRACT inTRodUCTion in the north Trent Cancer network (nTCn) patients requiring retroperitoneal lymphadenectomy for metastatic testicular cancer have been treated by vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours. PaTiEnTS and mEThodS Patients referred by the nTCn to the vascular service for retroperitoneal lymphadenectomy between 1990 and 2009 were identified through a germ cell database. data were supplemented by a review of case notes to record histology, intraoperative and postoperative details. RESULTS a total of 64 patients were referred to the vascular service for retroperitoneal lymph node dissection, with a median age of 29 years (16-63 years) and a median follow-up of 4.9 years. Ten patients ...

Mesotelioma de túnica vaginal en paciente con hidrocele rápidamente progresivo

“…La linfadenectomía retroperitoneal tiene fines diagnósticos y terapéuticos. 9 Por otro lado, la radioterapia puede incluirse como estrategia preventiva, como parte del manejo paliativo o como tratamiento de recaída local. 2 La quimioterapia se ha empleado en enfermedad metastásica, aunque su impacto es bastante limitado.…”