Primary Retroperitoneal Lymph Node Dissection in Patients With Clinical Stage IS Testis Cancer

Stephen B. Williams, Graeme S. Steele, Jerome P. Richie

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Initial management for clinical stage IS (persistently increased tumor markers) nonseminomatous germ cell tumor has evolved from primary retroperitoneal lymph node dissection to induction chemotherapy at most medical centers. We analyzed the outcome in patients treated with primary retroperitoneal lymph node dissection. Materials and Methods: We reviewed the charts of patients who underwent retroperitoneal lymph node dissection at Brigham and Women's Hospital, and Dana Farber Cancer Center from 1993 to 2008. All patients with clinical stage IS were identified and perioperative data were obtained. Results: A total of 280 patients who underwent retroperitoneal lymph node dissection were identified, of whom 24 identified with clinical stage IS underwent primary dissection. Median followup was 2.9 years. Histopathology revealed an embryonal carcinoma component in 24 orchiectomy specimens (100%) with associated teratoma in 15 (63%). Positive lymph nodes were identified at retroperitoneal lymph node dissection in 9 patients (38%), including pure embryonal carcinoma in 6 (67%), combined embryonal carcinoma and teratoma in 1, embryonal carcinoma, choriocarcinoma and teratoma in 1, and only teratoma in 1. Of the patients who underwent primary retroperitoneal lymph node dissection 5 (21%) also received chemotherapy postoperatively, which was due to persistently increased tumor markers in 3 (13%). No retroperitoneal recurrence was noted on followup imaging. At surgery estimated blood loss was 175 cc, operative time was 3.1 hours and hospital stay was 3.9 days. There were no deaths. Conclusions: Patients with clinical stage IS are at significant risk for metastatic disease and can be successfully treated with primary retroperitoneal lymph node dissection, thereby sparing chemotherapy in most of them. Retroperitoneal recurrence is essentially eliminated when retroperitoneal lymph node dissection is performed in this select patient group.

Original languageEnglish (US)
Pages (from-to)2716-2720
Number of pages5
JournalJournal of Urology
Volume182
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Testicular Neoplasms
Lymph Node Excision
Embryonal Carcinoma
Teratoma
Tumor Biomarkers
Recurrence
Drug Therapy
Choriocarcinoma
Induction Chemotherapy
Orchiectomy
Operative Time
Dissection
Length of Stay
Lymph Nodes

Keywords

  • germ cell and embryonal
  • lymph node excision
  • neoplasm staging
  • neoplasms
  • risk
  • testis

ASJC Scopus subject areas

  • Urology

Cite this

Primary Retroperitoneal Lymph Node Dissection in Patients With Clinical Stage IS Testis Cancer. / Williams, Stephen B.; Steele, Graeme S.; Richie, Jerome P.

In: Journal of Urology, Vol. 182, No. 6, 12.2009, p. 2716-2720.

Research output: Contribution to journalArticle

Williams, Stephen B. ; Steele, Graeme S. ; Richie, Jerome P. / Primary Retroperitoneal Lymph Node Dissection in Patients With Clinical Stage IS Testis Cancer. In: Journal of Urology. 2009 ; Vol. 182, No. 6. pp. 2716-2720.
@article{571a2f3f6c2f4040b04606368e1310df,
title = "Primary Retroperitoneal Lymph Node Dissection in Patients With Clinical Stage IS Testis Cancer",
abstract = "Purpose: Initial management for clinical stage IS (persistently increased tumor markers) nonseminomatous germ cell tumor has evolved from primary retroperitoneal lymph node dissection to induction chemotherapy at most medical centers. We analyzed the outcome in patients treated with primary retroperitoneal lymph node dissection. Materials and Methods: We reviewed the charts of patients who underwent retroperitoneal lymph node dissection at Brigham and Women's Hospital, and Dana Farber Cancer Center from 1993 to 2008. All patients with clinical stage IS were identified and perioperative data were obtained. Results: A total of 280 patients who underwent retroperitoneal lymph node dissection were identified, of whom 24 identified with clinical stage IS underwent primary dissection. Median followup was 2.9 years. Histopathology revealed an embryonal carcinoma component in 24 orchiectomy specimens (100{\%}) with associated teratoma in 15 (63{\%}). Positive lymph nodes were identified at retroperitoneal lymph node dissection in 9 patients (38{\%}), including pure embryonal carcinoma in 6 (67{\%}), combined embryonal carcinoma and teratoma in 1, embryonal carcinoma, choriocarcinoma and teratoma in 1, and only teratoma in 1. Of the patients who underwent primary retroperitoneal lymph node dissection 5 (21{\%}) also received chemotherapy postoperatively, which was due to persistently increased tumor markers in 3 (13{\%}). No retroperitoneal recurrence was noted on followup imaging. At surgery estimated blood loss was 175 cc, operative time was 3.1 hours and hospital stay was 3.9 days. There were no deaths. Conclusions: Patients with clinical stage IS are at significant risk for metastatic disease and can be successfully treated with primary retroperitoneal lymph node dissection, thereby sparing chemotherapy in most of them. Retroperitoneal recurrence is essentially eliminated when retroperitoneal lymph node dissection is performed in this select patient group.",
keywords = "germ cell and embryonal, lymph node excision, neoplasm staging, neoplasms, risk, testis",
author = "Williams, {Stephen B.} and Steele, {Graeme S.} and Richie, {Jerome P.}",
year = "2009",
month = "12",
doi = "10.1016/j.juro.2009.08.038",
language = "English (US)",
volume = "182",
pages = "2716--2720",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Primary Retroperitoneal Lymph Node Dissection in Patients With Clinical Stage IS Testis Cancer

AU - Williams, Stephen B.

AU - Steele, Graeme S.

AU - Richie, Jerome P.

PY - 2009/12

Y1 - 2009/12

N2 - Purpose: Initial management for clinical stage IS (persistently increased tumor markers) nonseminomatous germ cell tumor has evolved from primary retroperitoneal lymph node dissection to induction chemotherapy at most medical centers. We analyzed the outcome in patients treated with primary retroperitoneal lymph node dissection. Materials and Methods: We reviewed the charts of patients who underwent retroperitoneal lymph node dissection at Brigham and Women's Hospital, and Dana Farber Cancer Center from 1993 to 2008. All patients with clinical stage IS were identified and perioperative data were obtained. Results: A total of 280 patients who underwent retroperitoneal lymph node dissection were identified, of whom 24 identified with clinical stage IS underwent primary dissection. Median followup was 2.9 years. Histopathology revealed an embryonal carcinoma component in 24 orchiectomy specimens (100%) with associated teratoma in 15 (63%). Positive lymph nodes were identified at retroperitoneal lymph node dissection in 9 patients (38%), including pure embryonal carcinoma in 6 (67%), combined embryonal carcinoma and teratoma in 1, embryonal carcinoma, choriocarcinoma and teratoma in 1, and only teratoma in 1. Of the patients who underwent primary retroperitoneal lymph node dissection 5 (21%) also received chemotherapy postoperatively, which was due to persistently increased tumor markers in 3 (13%). No retroperitoneal recurrence was noted on followup imaging. At surgery estimated blood loss was 175 cc, operative time was 3.1 hours and hospital stay was 3.9 days. There were no deaths. Conclusions: Patients with clinical stage IS are at significant risk for metastatic disease and can be successfully treated with primary retroperitoneal lymph node dissection, thereby sparing chemotherapy in most of them. Retroperitoneal recurrence is essentially eliminated when retroperitoneal lymph node dissection is performed in this select patient group.

AB - Purpose: Initial management for clinical stage IS (persistently increased tumor markers) nonseminomatous germ cell tumor has evolved from primary retroperitoneal lymph node dissection to induction chemotherapy at most medical centers. We analyzed the outcome in patients treated with primary retroperitoneal lymph node dissection. Materials and Methods: We reviewed the charts of patients who underwent retroperitoneal lymph node dissection at Brigham and Women's Hospital, and Dana Farber Cancer Center from 1993 to 2008. All patients with clinical stage IS were identified and perioperative data were obtained. Results: A total of 280 patients who underwent retroperitoneal lymph node dissection were identified, of whom 24 identified with clinical stage IS underwent primary dissection. Median followup was 2.9 years. Histopathology revealed an embryonal carcinoma component in 24 orchiectomy specimens (100%) with associated teratoma in 15 (63%). Positive lymph nodes were identified at retroperitoneal lymph node dissection in 9 patients (38%), including pure embryonal carcinoma in 6 (67%), combined embryonal carcinoma and teratoma in 1, embryonal carcinoma, choriocarcinoma and teratoma in 1, and only teratoma in 1. Of the patients who underwent primary retroperitoneal lymph node dissection 5 (21%) also received chemotherapy postoperatively, which was due to persistently increased tumor markers in 3 (13%). No retroperitoneal recurrence was noted on followup imaging. At surgery estimated blood loss was 175 cc, operative time was 3.1 hours and hospital stay was 3.9 days. There were no deaths. Conclusions: Patients with clinical stage IS are at significant risk for metastatic disease and can be successfully treated with primary retroperitoneal lymph node dissection, thereby sparing chemotherapy in most of them. Retroperitoneal recurrence is essentially eliminated when retroperitoneal lymph node dissection is performed in this select patient group.

KW - germ cell and embryonal

KW - lymph node excision

KW - neoplasm staging

KW - neoplasms

KW - risk

KW - testis

UR - http://www.scopus.com/inward/record.url?scp=71849083564&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=71849083564&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2009.08.038

DO - 10.1016/j.juro.2009.08.038

M3 - Article

VL - 182

SP - 2716

EP - 2720

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -