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Retroperitoneal surgery in patients with nonseminomatous testicular cancer and minimal residual tumor
Author(s) -
Qvist Hanne,
Fosså Sophie Dorothea,
Ous Sigurd,
Lien Hans H.,
Stenwig Anna E.,
Giercksky KarlErik
Publication year - 1992
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930500404
Subject(s) - medicine , surgery , ejaculation , lymphadenectomy , testicular cancer , retroperitoneal space , dissection (medical) , retroperitoneal lymph node dissection , radiation therapy , chemotherapy , cancer
In the period 1980–1991, 78 patients with advanced nonseminomatous testicular cancer underwent retroperitoneal lymphadenectomy for post‐chemotherapy residual masses <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. © 1992 Wiley‐Liss, Inc.