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Primary Retroperitoneal Lymph Node Dissection in Clinical Stage A Non‐seminomatous Germ Cell Testis Cancer Review of the Indiana University Experience 1965–1989
Author(s) -
DONOHUE J. P.,
THORNHILL J. A.,
FOSTER R. S.,
ROWLAND R. G.,
BIHRLE R.
Publication year - 1993
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1993.tb15952.x
Subject(s) - retroperitoneal lymph node dissection , medicine , stage (stratigraphy) , radiation therapy , testicular cancer , dissection (medical) , seminoma , pathological , surgery , lymph node , cancer , chemotherapy , oncology , paleontology , biology
Summary— The results of primary retroperitoneal lymph node dissection (RPLND) in 464 patients with clinical stage A non‐seminomatous germ cell (NSGC) testis cancer treated over 25 years (1965–1989) were reviewed. The results were analysed in clinical terms and subdivided into early (1965–1978) and contemporary (1979–1989) groups in order to be comparable with series using radiotherapy or surveillance. Between 1965 and 1978 (86 clinical stage A patients) the overall relapse rate of 15% (n = 13) was similar to that of radiotherapy series but survival (97.7% after RPLND) was superior to that achieved with irradiation (87%). From 1979 to 1989, 378 clinical stage A patients had primary RPLND and 30% of them (n = 112) had cancerous nodes. The relapse rate for pathological stage A (n = 266) was 12% and 2 patients died. The relapse rate in pathological stage B patients without adjuvant chemotherapy was 34%. No relapse was seen among 48 pathological stage B patients who received post‐operative adjuvant chemotherapy. The death rate was 0.8% among 378 clinical stage A RPLND patients. While not statistically significantly different from death rates reported in current surveillance series, these consistent results spanning 2 eras (before and after cisplatin) over 25 years suggest a sound basis for the surgical approach. The anatomical and medical principles in oncology, which have supported this approach, still remain cogent today. Now that nerve‐sparing techniques have been developed, the only long‐term morbidity of RPLND (anejaculation) has been avoided. It would seem appropriate to include nerve‐sparing RPLND techniques in the management of clinical stage A disease.