Reoperative RPLND for testicular germ cell tumor - Abstract

[Paul54]

Reoperative retroperitoneal lymph-node dissection for testicular germ cell tumor - Abstract

Wednesday, 23 September 2009
Department of Urology, Columbia University Medical Center, New York, NY 10032, USA.

We sought to discuss the indications for reoperative retroperitoneal surgery, preoperative evaluation of patients, distribution of retroperitoneal recurrences and technical considerations for reoperative procedures. In addition, the histologic findings, clinical outcomes and perioperative complications were reviewed.

A PubMED and Medline search was performed to identify reoperative retroperitoneal surgery series for patients with nonseminomatous germ cell tumor.

A reliance on cisplatin-based chemotherapy to treat residual disease after RPLND is inadequate for most patients. If retroperitoneal failure does occur, reoperative RPLND should be considered as the recurrence can harbor viable GCT or teratoma, which both necessitate surgical excision. The left para-aortic and left renal hilar regions are the most common sites of retroperitoneal failure. Reoperative retroperitoneal surgery can be performed with an acceptable morbidity as long as surgeons are equipped to handle significant intraoperative complications. Clinical outcomes after reoperative RPLND are influenced by serum tumor markers, histologic findings and completeness of surgical resection.

Overall survival rates in men requiring redo RPLND appear significantly lower than similar patients who are successfully treated with their initial RPLND. Given the potential complexity of this operation and its impact on a patient's prognosis, reoperative RPLND surgery should be limited to specialized quaternary care centers.

Written by:
Murphy AM, McKiernan JM

Reference:
World J Urol. 2009 Aug;27(4):501-6.
doi:10.1007/s00345-009-0457-2

PubMed Abstract
PMID:19636565

UroToday.com Testicular Cancer Section

[Pattytricia]

Hi,

Regarding the following quote -

"reoperative RPLND surgery should be limited to specialized quaternary care centers."

Which centers would be the best?

Thank for your opinion.
P

[Jarrod]

University of Indiana in Indy is the best hosptial for this operation. Dr. Richard Foster is one of the best Urologist in the World.

[Pattytricia]

Thanks, Jarrod. We will be going to Dr Einhorn for his opinion in 10 days.
P

[hismom]

Dr. Joel Schienfeld at Sloan Kettering is a master of RPLND and a genius at nerve sparing. My son had the surgery on Friday and he was able to spare the nerves which is much more difficult after chemo. My son had 4 rounds EP before the surgery because he was diagnosed at stage III non-sem EC,yolk sac,teratoma. He is getting excellent care as we speak. Hope this helps, we'll be praying for you.

[Pattytricia]

Dear Hismom,
Thank you for recommending Dr. S. I am glad things are going well for you.
Thank you so much for your prayers. We head to Indiana on Monday to get their opinion.
Take care and praying for the best for your son.
P