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RPLND for testicular cancer

Sumeet Syan-Bhanvadia, Soroush T Bazargani, Thomas G Clifford, Jie Cai, Gus Miranda, Siamak Daneshmand
BACKGROUND: Retroperitoneal lymph node dissection (RPLND) is an important component of the management of testicular germ cell tumor (GCT) but carries significant surgical morbidity. OBJECTIVE: To describe our experience with a midline extraperitoneal (EP) approach to RPLND for seminomatous and nonseminomatous GCT. DESIGN, SETTING, AND PARTICIPANTS: From 2010 to 2015, 122 consecutive patients underwent RPLND from a prospective database. Patients requiring aortic resection or retrocrural dissection or with intraperitoneal disease were excluded...
March 18, 2017: European Urology
Jane S Cho, Hristos Z Kaimakliotis, Clint Cary, Timothy A Masterson, Stephen Beck, Richard Foster
OBJECTIVE: To update previously reported outcomes of modified-template post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in appropriately selected patients with metastatic non-seminomatous germ cell tumour (NSGCT), as our previous report was criticised for short follow-up and so we now provide a long-term update on this cohort. PATIENTS AND METHODS: In all, 100 patients with normal serum markers after cisplatin-based chemotherapy and residual retroperitoneal tumour underwent modified PC-RPLND between 1991 and 2004...
July 2017: BJU International
K Yadav
Management of testicular cancer has evolved through many breakthroughs. The decades of zeal to improve oncologic adequacy and to decrease morbidity has led to the current scientific knowledge of retroperitoneal lymph node dissection templates. Retroperitoneal lymph node dissection (RPLND) has potential for staging, prognostication and therapeutic importance in the management of testicular malignancy. RPLND has overcome limitations of current imaging which understage 30% of stage I disease and overstage 25-30% of stage II disease...
July 2017: Clinical & Translational Oncology
Alessandro Crestani, Francesco Esperto, Marta Rossanese, Gianluca Giannarini, Nicola Nicolai, Vincenzo Ficarra
Retroperitoneal lymphnode dissection (RPLND) is a fundamental surgical step in the treatment of testicular cancer. Nowadays primary RPLND has partially lost its role in favour of active surveillance (for low risk stage I disease) and short cycle chemotherapy in non-seminomatous germ cell tumour (NSGCT). Conversely, postchemotherapy-RPLND (PC-RPLND) remains the standard treatment for residual masses after chemotherapy. In consideration of curability rate of testicular cancer and the life expectancy of testicular cancer survivors the identification and the prevention of andrological complications became fundamental...
November 23, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Marie Dusaud, Bernard Malavaud, Younes Bayoud, Philippe Sebe, Jean Luc Hoepffner, Laurent Salomon, Alain Houlgatte, Géraldine Pignot, Jérome Rigaud, Aude Fléchon, Christian Pfister, Morgan Rouprêt, Michel Soulié, Arnaud Méjean, Xavier Durand
BACKGROUND AND OBJECTIVES: To identify predictive preoperative factors of the presence of teratoma in retroperitoneal lymph node dissection specimens. METHODS: We performed a 20 years multicenter retrospective analysis of all patients who underwent retroperitoneal lymph node dissection for residual masses after chemotherapy (PC-RPLND). Patients had undergone PC-RPLND after chemotherapy for advanced testicular cancer. The histologic components of the primary tumor were compared with those of the residual masses using logistic regression...
December 2016: Journal of Surgical Oncology
A Heidenreich, F Haidl, P Paffenholz, Ch Pape, U Neumann, D Pfister
Background: Post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) represents the treatment of choice in patients with residual masses following chemotherapy for metastatic germ cell tumours. Involvement of major retroperitoneal vessels or thoracic/lumbar spine is rare and challenging but needs complete resection for curative intent. We report on our experience in the management of such complex cases. Patients and methods: A total of 185 patients underwent PC-RPLND and we identified 25 (13...
February 1, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Michal Chovanec, Nasser Hanna, K Clint Cary, Lawrence Einhorn, Costantine Albany
Clinical stage I testicular germ cell tumours (TGCT) are highly curable neoplasms. The treatment of stage I testicular cancer is complex and requires a multidisciplinary approach. Standard options after radical orchiectomy for seminoma include active surveillance, radiation therapy or 1-2 cycles of carboplatin, and options for nonseminoma include active surveillance, retroperitoneal lymph node dissection (RPLND) or 1-2 cycles of bleomycin plus etoposide plus cisplatin (BEP). All the options should be discussed with each patient and treatment choices should be made by shared decision making as virtually all patients with clinical stage I TGCT can be cured of their disease...
November 2016: Nature Reviews. Urology
Thomas E Stout, Samit D Soni, Alvin C Goh
There have been no previous reports of post-chemotherapy robotic bilateral retroperitoneal lymph node dissection (RPLND) using a single-dock technique. One deterrent of robotic RPLND is that accessing bilateral retroperitoneal spaces requires patient reposition and surgical robot redocking, therefore increasing operative time. Herein we provide the first step-by-step description of a single-dock technique for robotic bilateral RPLND in the post-chemotherapy setting. We describe port placement and technique for robot positioning to optimize access to bilateral retroperitoneal spaces with a single dock...
December 2016: Journal of Robotic Surgery
Cory M Hugen, Brian Hu, Claudio Jeldres, Claire Burton, Craig R Nichols, Christopher R Porter, Siamak Daneshmand
INTRODUCTION: Retroperitoneal lymph node dissection (RPLND) for the treatment of testicular cancer is a relatively rare and complex operation that may contribute to differences in utilization. We sought to characterize the use of RPLND between different categories of cancer center facilities in the United States. MATERIALS AND METHODS: The National Cancer Database was queried for patients with germ cell tumors treated at different types of cancer centers between 1998 and 2011...
November 2016: Urologic Oncology
Shaheen R Alanee, Brett S Carver, Darren R Feldman, Robert J Motzer, George J Bosl, Joel Sheinfeld
OBJECTIVE: To describe the pathologic findings and clinical outcome data for patients undergoing pelvic lymph node dissection (PLND) in the course of management of testicular germ cell tumors at Memorial Sloan Kettering Cancer Center (MSKCC). PATIENTS AND METHODS: Following institutional review board approval, data on 2186 patients who underwent retroperitoneal lymph node dissection (RPLND) at MSKCC between 1989 and 2011 were retrospectively reviewed. Of these 2186 patients, we analyzed data for 44 patients (2%) who underwent PLND at the time of RPLND...
September 2016: Urology
Shane M Pearce, Shay Golan, Michael A Gorin, Amy N Luckenbaugh, Stephen B Williams, John F Ward, Jeffrey S Montgomery, Khaled S Hafez, Alon Z Weizer, Phillip M Pierorazio, Mohamad E Allaf, Scott E Eggener
BACKGROUND: Primary robot-assisted retroperitoneal lymph node dissection (R-RPLND) has been studied as an alternative to open RPLND in single-institution series for patients with low-stage nonseminomatous germ cell tumors (NSGCT). OBJECTIVE: To evaluate a multicenter series of primary R-RPLND for low-stage NSGCT. DESIGN, SETTING, AND PARTICIPANTS: Between 2011 and 2015, 47 patients underwent primary R-RPLND at four centers for Clinical Stage (CS) I-IIA NSGCT...
March 2017: European Urology
Anobel Y Odisho, Joseph T Rabban, Maxwell V Meng
A 29-year-old man presenting with a retroperitoneal mass was found to have a testis lesion consistent with mixed germ cell tumor and the RPLND specimen showed teratoma with an area of central nervous system-type primitive neuroectodermal tumor (PNET) not present in the testis. Whether such primitive tumor components represent a de novo tumor component or represent progression from existing neuroepithelial teratomatous elements is unclear. Given the high likelihood of residual tumor and possibility of malignant transformation, post-chemotherapy RPLND remains vital in treating patients with testis cancer...
May 2016: Urology Case Reports
Sevan Stepanian, Mayank Patel, James Porter
BACKGROUND: Retroperitoneal lymph node dissection (RPLND) is an accepted staging and treatment option for nonseminomatous germ cell tumor. Robotic surgery offers technical advantages and is being increasingly used in urologic procedures. OBJECTIVE: To determine the feasibility and safety of robotic surgery for RPLND. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of robotic (R)-RPLND performed by a single surgeon from April 2008 to October 2014 using two approaches was performed...
October 2016: European Urology
Heather J Chalfin, Wesley Ludwig, Phillip M Pierorazio, Mohamad E Allaf
Patients diagnosed with stage I non-seminomatous germ cell tumor (NSGCT) face the task of selecting a management strategy. Whereas these options all offer excellent survival, unfortunately, each has drawbacks. Retroperitoneal lymph node dissection (RPLND) is a major operation with low, but significant risks of bleeding, chylous ascites, and retrograde ejaculation. Platinum-based chemotherapy is associated with a number of long-term side effects, not all of which are quantified, but include secondary malignancy and early cardiovascular disease...
May 2016: Current Urology Reports
P Paffenholz, D Pfister, A Heidenreich
INTRODUCTION: Postchemotherapy residual tumour resection (PC-RTR) is an integral part of the multimodal therapy for advanced testicular germ cell tumours. Depending on the extent and localisation of the residual mass, PC-RTR may necessitate a multidisciplinary procedure (which should be planned preoperatively), to resolve even complex situations in an oncologically sound manner, with lower treatment-related morbidity The aim of article is to report on the interdisciplinary management of complex residual masses...
May 2016: Der Urologe. Ausg. A
Hans-Henning Flechtner, Florian Fischer, Peter Albers, Michael Hartmann, Roswitha Siener
BACKGROUND: The superiority of one course of bleomycin, etoposide, and cisplatin (BEP) over retroperitoneal lymph node dissection (RPLND) as adjuvant treatment in patients with clinical stage I nonseminomatous germ cell tumours (CSI-NSGCT) in terms of recurrence has been shown. However, studies providing validated prospective quality-of-life (QoL) data in patients with CSI-NSGCT treated with only one cycle of BEP are lacking. OBJECTIVE: To examine and compare QoL issues in patients with CSI-NSGCT after adjuvant treatment...
March 2016: European Urology
Mohamadreza Nowroozi, Mohsen Ayati, Amir Arbab, Hassan Jamshidian, Hamidreza Ghorbani, Hassan Niroomand, Mohsen Taheri Mahmoodi, Erfan Amini, Sohrab Salehi, Hamid Hakima, Farid Fazeli, Saeid Haghdani, Alireza Ghadian
BACKGROUND: Testicular cancer accounts for about 1 - 1.5% of all malignancies in men. Radical orchiectomy is curative in 75% of patients with stage I disease, but advance stage with retroperitoneal lymph node involvement needs chemotherapy. All patients who have residual masses ≥ 1 cm after chemotherapy should undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). OBJECTIVES: Treatment of advanced nonseminomatous testicular cancer is usually a combination of chemotherapy and surgery...
September 2015: Nephro-urology Monthly
Mohamed H Kamel, Mohammed Elfaramawi, Supriya Jadhav, Ahmed Saafan, Omer A Raheem, Rodney Davis
OBJECTIVE: To explore the relationship between insurance status and differences in treatment and survival of testicular cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study. MATERIALS AND METHODS: Between 2007 and 2011, 5986 testicular cancer patients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations...
January 2016: Urology
Clint Cary, Jose A Pedrosa, Joseph Jacob, Stephen D W Beck, Kevin R Rice, Lawrence H Einhorn, Richard S Foster
BACKGROUND: Characterizing the role of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) after high-dose chemotherapy (HDCT) has been limited by small sample sizes. This study reports on survival after HDCT with stem cell support and PC-RPLND as well as histologic findings in the retroperitoneum. METHODS: The prospectively maintained testicular cancer database of Indiana University was queried for patients receiving HDCT with stem cell transplantation before PC-RPLND...
December 15, 2015: Cancer
Haidar M Abdul-Muhsin, James O L'esperance, Kimberly Fischer, Michael E Woods, James R Porter, Erik P Castle
Robotic surgical techniques are now being applied in the setting of retroperitoneal lymphadenectomy (RPLND) for testicular cancer. While laparoscopic RPLND has not been widely accepted, reports of robot assisted RPLND (RARPLND) are emerging. This manuscript will review the application of RPLND for testicular cancer, evolution of minimally invasive techniques, the controversies, and current status of RARPLND.
December 2015: Journal of Surgical Oncology
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