Long-term oncological outcome after post-chemotherapy RPLND...-Abstract

[Paul54]

A French study. It makes the point that the best outcomes depend on complete RPLND's at the hands of highly skilled and expereinced surgeons. I would like to have seen a breakdown of cases and relapses by germ cell type. Perhaps that is covered in the full paper.

Long-term oncological outcome after post-chemotherapy retroperitoneal lymph node dissection in men with metastatic nonseminomatous germ cell tumour - Abstract

Thursday, 08 April 2010
Departments of Medical Oncology and Surgical Oncology, Centre Léon Bérard, Lyon, France.

Study Type - Prognosis (case series) Level of Evidence 4.

To determine whether conformity to standard recommendations of retroperitoneal lymph node dissection (RPLND) after chemotherapy for testicular and primary retroperitoneal nonseminomatous germ cell tumours (NSGCT) and completeness of surgical excision have an effect on oncological outcome.

This was a retrospective study of patients with testicular and primary retroperitoneal NSGCT, with initial involvement of RPLNs, treated between June 1992 and December 2002 in one institution. We reviewed the clinical, surgical and histological charts of 151 such patients who had a RPLND after first-line platinum-based chemotherapy. The recommendations used to define conformity to RPLND standards were: the indication based on initial and residual lymph node size, shrinkage, extension of dissection and completeness of resection.

RPLND conformed to standard recommendations in 70 of the 151 (46%) patients. Conformity was complete for the surgeon who operated on 48 patients and was 26% of the others. Fifteen patients (10%) relapsed in the retroperitoneum, 14 of whom had initial lymph nodes of >/=5 cm. Two patients (3%) relapsed in the group of 70 patients with conformed and complete RPLND, vs 13 (16%) in the 81 with conformed but incomplete resection or with non-conformed and complete or incomplete RPLND. After a median (range) follow-up of 77 (1.3-186.5) months 132 patients were alive with no evidence of disease, 18 died and one was alive with progressive disease. The limitations of this study were the relatively few patients and that it was retrospective.

There was conformity of RLNPD to the recommendations, and completeness of resection, in half of the patients operated; this might have an effect on oncological outcome. Our data suggest that patients should be treated in tertiary centres.

Written by:
Fléchon A, Tavernier E, Boyle H, Meeus P, Rivoire M, Droz JP.

Reference:
BJU Int. 2010 Jan 19. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.09175.x

PubMed Abstract
PMID:20089110

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