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Surgical Endoscopy

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Open Access 01-02-2012

Laparoscopic resection of a residual retroperitoneal tumor mass of nonseminomatous testicular germ cell tumors

Authors: Çiğdem Öztürk, Robert J. van Ginkel, Ruby M. Krol, Jourik A. Gietema, Hendrik S. Hofker, Harald J. Hoekstra

Published in: Surgical Endoscopy | Issue 2/2012

Abstract

Background

Resection of a residual retroperitoneal tumor mass (RRRTM) is standard procedure after combination chemotherapy for metastatic nonseminomatous testicular germ cell tumors (NSTGCT).

Methods

At the University Medical Center Groningen, 79 consecutive patients with disseminated NSTGCT were treated with cisplatin combination chemotherapy between 2005 and 2007. Laparoscopic RRRTM was performed for patients with RRTM located less than 5 cm ventrally or laterally from the aorta or the vena cava. The 29 patients who fulfilled the criteria had a median age of 25 years (range, 16–59 years). The stages of disease before chemotherapy treatment according to the Royal Marsden classification were 2A (n = 6, 21%), 2B (n = 14, 48%), 2C (n = 3, 10%), and 4 with a lymph node status of N2 (n = 6, 21%).

Results

The median duration of laparoscopy was 198 min (range, 122–325 min). The median diameter of the RRTM was 21 mm (range, 11–47 mm). Laparoscopic resection was successful for 25 patients (86%). Conversion was necessary for three patients (10%): two due to bleeding and one because of obesity. One nonplanned hand-assisted procedure (3%) also had to be performed. Histologic examination of the specimens showed fibrosis or necrosis in 12 patients (41%), mature teratoma in 16 patients (55%), and viable tumor in 1 patient (3%). The median hospital stay was 1 day (range, 1–6 days). During a median follow-up period of 47 months (29–70 months), one patient experienced an early relapse (1 month after the end of treatment) (4%).

Conclusion

For properly selected patients, laparoscopic resection of RRTM is an improvement in the combined treatment of disseminated NSTGCT and associated with a short hospital stay, minimal morbidity, rapid recovery, and a neat cosmetic result. Long-term data to prove oncologic efficacy are awaited.

Sonneveld DJ, Hoekstra HJ, van der Graaf WT, Sluiter WJ, Mulder NH, Willemse PH et al (2001) Improved long-term survival of patients with metastatic nonseminomatous testicular germ cell carcinoma in relation to prognostic classification systems during the cisplatin era. Cancer 91:1304–1315PubMedCrossRef

International Germ Cell Cancer Collaborative Group (1997) International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 15:594–603

Huddart RA (2007) Testicular seminoma: ESMO clinical recommendations for diagnosis, treatment, and follow-up. Ann Oncol 18(Suppl 2):ii40–ii41

Oldenburg J, Alfsen GC, Lien HH, Aass N, Waehre H, Fossa SD (2003) Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. J Clin Oncol 21:3310–3317PubMedCrossRef

Kesler KA, Kruter LE, Perkins SM, Rieger KM, Sullivan KJ, Runyan ML, Brown JW, Einhorn LH (2011) Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum. Ann Thorac Surg 91:1085–1093PubMedCrossRef

Ozen H, Ekici S, Sozen S, Ergen A, Tekgül S, Kendi S (2001) Resection of residual masses alone: an alternative in surgical therapy of metastatic testicular germ cell tumors after chemotherapy. Urology 57:323–327PubMedCrossRef

Rabbani F, Goldenberg SL, Gleave ME, Paterson RF, Murray N, Sullivan LD (1998) Retroperitoneal lymphadenectomy for postchemotherapy residual masses: is a modified dissection and resection of residual masses sufficient? Br J Urol 81:295–300PubMedCrossRef

Carver BS, Cronin AM, Eggener S, Savage CJ, Motzer RJ, Bajorin D, Bosl GJ (2010) The total number of retroperitoneal lymph nodes resected impacts clinical outcome after chemotherapy for metastatic testicular cancer. J Urol 75:1431–1435

Large MC, Sheinfeld J, Eggener SE (2009) Retroperitoneal lymph node dissection: reassessment of modified templates. BJU Int 104:1369–1375PubMedCrossRef

10.

Heidenreich A, Pfister D, Witthuhn R, Thüer D, Albers P (2009) Postchemotherapy retroperitoneal lymp node dissection in advanced testicular cancer: radical of modified template resection. Eur Urol 55:217–224PubMedCrossRef

11.

Steyerberg EW, Keizer HJ, Fosså SD, Sleijfer DT, Toner GC, Schraffordt Koops H, Mulders PF, Messemer JE, Ney K, Donohue JP et al (1995) Prediction of residual retroperitoneal mass histology after chemotherapy for metastatic nonseminomatous germ cell tumor: multivariate analysis of individual patient data from six study groups. J Clin Oncol 13:1177–1187PubMed

12.

Vergouwe Y, Steyerberg EW, Foster RS, Sleijfer DT, Fosså SD, Gerl A, de Wit R, Roberts JT, Habbema JD (2007) Predicting retroperitoneal histology in postchemotherapy testicular germ cell cancer: a model update and multicentre validation with more than 1000 patients. Eur Urol 51:424–432PubMedCrossRef

13.

Oechsle K, Hartmann M, Brenner W, Venz S, Weissbach L, Franzius C et al (2008) [18F]Fluorodeoxyglucose positron emission tomography in nonseminomatous germ cell tumors after chemotherapy: the German multicenter positron emission tomography study group. J Clin Oncol 26:5930–5935PubMedCrossRef

14.

van Basten JP, Jonker-Pool G, Van Driel MF, Sleijfer DT, van der Wiel HB, Hoekstra HJ (1995) The sexual sequelae of testicular cancer. Cancer Treat Rev 21:479–495PubMedCrossRef

15.

Pettus JA, Carver BS, Masterson T, Stasi J, Sheinfeld J (2009) Preservation of ejaculation in patients undergoing nerve-sparing postchemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer. Urology 73:328–331PubMedCrossRef

16.

Gelderman WA, Schraffordt Koops H, Sleijfer DT, Oosterhuis JW, Van der Heide JN, Mulder NH et al (1988) Results of adjuvant surgery in patients with stage III and IV nonseminomatous testicular tumors after cisplatin-vinblastine-bleomycin chemotherapy. J Surg Oncol 38:227–232PubMedCrossRef

17.

Rukstalis DB, Chodak GW (1992) Laparoscopic retroperitoneal lymph node dissection in a patient with stage 1 testicular carcinoma. J Urol 148:1907–1909PubMed

18.

Bhayani SB, Ong A, Oh WK, Kantoff PW, Kavoussi LR (2003) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer: a long-term update. Urology 62:324–327PubMedCrossRef

19.

Nielsen ME, Lima G, Schaeffer EM, Porter J, Cadeddu JA, Tuerk I, Kavoussi LR (2007) Oncologic efficacy of laparoscopic RPLND in treatment of clinical stage I nonseminomatous germ cell testicular cancer. Urology 70:1168–1172PubMedCrossRef

20.

Rassweiler JJ, Seemann O, Henkel TO, Stock C, Frede T, Alken P (1996) Laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors: indications and limitations. J Urol 156:1108–1113PubMedCrossRef

21.

Palese MA, Su LM, Kavoussi LR (2002) Laparoscopic retroperitoneal lymph node dissection after chemotherapy. Urology 60:130–134PubMedCrossRef

22.

Steiner H, Peschel R, Janetschek G, Holtl L, Berger AP, Bartsch G et al (2004) Long-term results of laparoscopic retroperitoneal lymph node dissection: a single-center 10-year experience. Urology 63:550–555PubMedCrossRef

23.

Albqami N, Janetschek G (2005) Laparoscopic retroperitoneal lymph node dissection in the management of clinical stage I and II testicular cancer. J Endourol 19:683–692PubMedCrossRef

24.

Permpongkosol S, Lima GC, Warlick CA, Allaf ME, Varkarakis IM, Bagga HS et al (2007) Postchemotherapy laparoscopic retroperitoneal lymph node dissection: evaluation of complications. Urology 69:361–365PubMedCrossRef

25.

Maldonado-Valadez R, Schilling D, Anastasiadis AG, Sturm W, Stenzl A, Corvin S (2007) Postchemotherapy laparoscopic retroperitoneal lymph node dissection in testis cancer patients. J Endourol 21:1501–1504PubMedCrossRef

26.

Calestroupat JP, Sanchez-Salas R, Cathelineau X, Rozet F, Galiano M, Smyth G et al (2009) Postchemotherapy laparoscopic retroperitoneal lymph node dissection in nonseminomatous germ cell tumor. J Endourol 23:645–650PubMedCrossRef

27.

Evans JG, Spiess PE, Kamat AM, Wood CG, Hernandez M, Pettaway CA et al (2006) Chylous ascites after postchemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience. J Urol 176(4 Pt 1):1463–1467PubMedCrossRef

28.

Shahidi M, Norman AR, Dearnaley DP, Nicholls J, Horwich A, Huddart RA (2002) Late recurrence in 1263 men with testicular germ cell tumors. Multivariate analysis of risk factors and implications for management. Cancer 95:520–530PubMedCrossRef

29.

Baniel J, Foster RS, Gonin R, Messemer JE, Donohue JP, Einhorn LH (1995) Late relapse of testicular cancer. J Clin Oncol 13:1170–1176PubMed

30.

Sharp DS, Carver BS, Eggener SE, Kondagunta GV, Motzer RJ, Bosl GJ et al (2008) Clinical outcome and predictors of survival in late relapse of germ cell tumor. J Clin Oncol 26:5524–5529PubMedCrossRef

31.

Carver BS, Shayegan B, Eggener S, Stasi J, Motzer RJ, Bosl GJ et al (2007) Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol 25:4365–4369PubMedCrossRef

Title: Laparoscopic resection of a residual retroperitoneal tumor mass of nonseminomatous testicular germ cell tumors
Authors: Çiğdem Öztürk
Robert J. van Ginkel
Ruby M. Krol
Jourik A. Gietema
Hendrik S. Hofker
Harald J. Hoekstra
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1901-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic resection of a residual retroperitoneal tumor mass of nonseminomatous testicular germ cell tumors

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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