Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Aufderklamm, S; Todenhöfer, T; Hennenlotter, J; Mischinger, J; Böttge, J; Rausch, S; Halalsheh, O; Stenzl, A; Gakis, G; Schwentner, C.
Postchemotherapy laparoscopic retroperitoneal lymph node dissection for nonseminomatous germ cell tumors infiltrating the great vessels.
J Endourol. 2014; 28(6):668-674 Doi: 10.1089/end.2013.0755
Web of Science PubMed FullText FullText_MUG

Co-Autor*innen der Med Uni Graz: Mischinger Johannes
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Abstract:: Laparoscopic retroperitoneal lymph node dissection (L-RPLND) is an alternative in patients with metastatic nonseminomatous germcell tumors (NSGCT) necessitating resection of residuals postchemotherapy. With the advancement of laparoscopic vascular surgery, prospective management of the great vessels has become feasible and safe. We present our experience with L-RPLND in NSGCT residuals with significant vascular involvement necessitating intracorporeal reconstruction. We have retrospectively identified 19 NSGCT patients (mean age 27 years) who presented with residuals postchemotherapy. A bilateral L-RPLND was performed in all men. Infiltration of the great vessels was confirmed intraoperatively. Prospective vascular control and temporary clamping was performed in all cases. The vessel wall was reconstructed using vascular surgery techniques. All patients had at least clinical stages of IIA or higher. Follow-up was obtained in all. There were no conversions to open surgery. The mean size of the residuals after chemotherapy was 3.87 cm (1.5-9.7 cm). The mean blood loss was 310 mL (50-1000 mL). Mean hospital stay was 6 days (3-9 days). There were no perioperative complications exceeding grade II according to the Clavien-Dindo classification. Distant or in-field recurrence (mean observational period 18 months) did not develop in any patient. Laparoscopic RPLND may be considered a safe alternative concept for the management of post-chemotherapy NSGCT residuals involving the great vessels. Bilateral L-RPLND in patients with vascular infiltration is feasible and reproducible when laparoscopic vascular surgery can be reliably handled. All standard principles of open surgery are respected, and initial oncologic results are promising.
Find related publications in this database (using NLM MeSH Indexing): Adult -; Aorta - pathology; Aorta - surgery; Humans -; Laparoscopy - methods; Length of Stay -; Lymph Node Excision - methods; Male -; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging -; Neoplasm, Residual - pathology; Neoplasms, Germ Cell and Embryonal - drug therapy; Neoplasms, Germ Cell and Embryonal - secondary; Neoplasms, Germ Cell and Embryonal - surgery; Retroperitoneal Neoplasms - drug therapy; Retroperitoneal Neoplasms - secondary; Retroperitoneal Neoplasms - surgery; Retroperitoneal Space - surgery; Retrospective Studies -; Testicular Neoplasms - surgery; Venae Cavae - pathology; Venae Cavae - surgery