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Aufderklamm, S; Todenhöfer, T; Hennenlotter, J; Gakis, G; Mischinger, J; Mundhenk, J; Germann, M; Stenzl, A; Schwentner, C.
Post-chemotherapy laparoscopic retroperitoneal lymph node dissection in low volume residual germ cell cancer: a technique to reduce morbidity].
Urologe A. 2013; 52(8):1097-1103
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Autor/innen der Med Uni Graz:
Mischinger Johannes
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Abstract:
Retroperitoneal lymph node dissection (RPLND) is the most appropriate method for the detection of residual tumor tissue and mature teratoma after chemotherapy in patients with advanced nonseminomatous (NSGCT) or seminomatous (SGCT) germ cell tumors in clinical stage II-III. Open surgical procedures are associated with higher morbidity rates and laparoscopic RPLND offers a minimally invasive procedure with equivalent oncological safety and low morbidity. In 39 patients laparoscopic RPLND (L-RPLND) after platinum-based chemotherapy for clinical stage IIa-III NSGCT was performed unilaterally as well as bilaterally by two surgeons. Patients with retroperitoneal residual tumor >1 cm and normalization of tumor markers after chemotherapy were included. Bilateral L-RPLND was performed with complete contralateral nerve sparing while the decision for ipsilateral nerve preservation was based on the volume of the residual mass in the respective standard field. The L-RPLND was completed in all patients without conversion. Median operation time was 248 min (range 95-397 min) and mean hospitalization time was 5 days (range 3-14 days). Furthermore, there was no difference in recurrence rate of the disease (p=0.45) between patients with unilateral or bilateral dissection. The postoperative ejaculatory function was normal in 37 out of 39 patients. The median follow-up period was 18.5 months (range 3-38 months) and 3 out of 39 patients developed recurrence (7.69 %). Post-chemotherapy L-RPLND is feasible with a lower complication rate and an adequate oncological safety and functional outcome. Due to the complexity of L-RPLND the procedure remains limited to institutions with extensive laparoscopic experience.
Find related publications in this database (using NLM MeSH Indexing)
Adolescent -
Adult -
Antineoplastic Agents - therapeutic use
Combined Modality Therapy - methods
Humans -
Laparoscopy - methods
Lymph Node Excision - methods
Lymph Nodes - pathology
Lymph Nodes - surgery
Lymphatic Metastasis -
Male -
Middle Aged -
Neoplasm, Residual -
Retroperitoneal Space - pathology
Retroperitoneal Space - surgery
Seminoma - pathology
Seminoma - therapy
Testicular Neoplasms - pathology
Testicular Neoplasms - therapy
Treatment Outcome -
Tumor Burden -
Young Adult -

Find related publications in this database (Keywords)
Testicular cancer
Morbidity, operative
Space-occupying lesion, persisting
Chemotherapy, platinum-based
Resection, bilateral
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