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Fabio C M Torricelli, Denis Jardim, Giuliano B Guglielmetti, Vipul Patel, Rafael F Coelho
INTRODUCTION AND OBJECTIVE: Retroperitoneal lymph node dissection (RPLND) is indicated for patients with non-seminoma¬tous germ cell tumor (NSGCT) with residual disease after chemotherapy. Although the gold standard approach is still the open surgery, few cases of robot-assisted laparoscopic RPLND have been described. Herein, we aim to present the surgical technique for robot-assisted laparoscopic RPLND. PATIENT AND METHOD: A 30 year-old asymptomatic man presented with left testicular swelling for 2 months...
October 25, 2016: International Braz J Urol: Official Journal of the Brazilian Society of Urology
Roy Mano, Maria F Becerra, Brett S Carver, George J Bosl, Robert J Motzer, Dean F Bajorin, Darren R Feldman, Joel Sheinfeld
PURPOSE: Fibrosis accounts for approximately 50% of histological findings at post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and is associated with reported relapse rates of 10%-15%. We aimed to characterize patients with fibrosis at PC-RPLND, and identify predictors of adverse outcome within this group. MATERIALS AND METHODS: We reviewed the medical records of men who underwent PC-RPLND between 1989-2013 with histological findings of necrosis/fibrosis...
October 5, 2016: Journal of Urology
Joseph M Jacob, Clint Cary, Song Jiang, Richard S Foster, Michael G House
OBJECTIVE: To describe patient characteristics and outcomes after duodenal repair during PC-RPLND and to identify treatment and management patterns METHODS: The Indiana University Testis Cancer Database was used to identify all patients who underwent simultaneous partial duodenectomy and PC-RPLND from 1983 to 2013. Patient records were reviewed to describe patient and tumor characteristics, type of duodenal restoration, postoperative management and complications. RESULTS: Of the 2,223 PC-RPLND performed during the study period, 39 patients were identified who underwent simultaneous duodenectomy with one patient requiring 2 duodenal procedures for a total of 40 duodenal procedures...
September 19, 2016: Urology
Adam B Weiner, Shane M Pearce, Scott E Eggener
BACKGROUND: Surveillance has been recommended more frequently as a postorchiectomy management option for men with early stage nonseminomatous germ cell tumor (NSGCT) of the testicle. It is unknown how contemporary treatment patterns reflect these recommendations. METHODS: Data from the National Cancer Database were extracted on all men who were diagnosed with clinical stage (CS) IA or CSIB NSGCT between 2004 and 2013. Temporal trends in the use of chemotherapy, retroperitoneal lymph node dissection (RPLND), and surveillance were measured; and multivariable logistic regression was used to analyze the association of patient and clinical covariates with use of surveillance...
September 14, 2016: Cancer
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...
September 13, 2016: Nature Reviews. Urology
Nicola Nicolai, Francesco Cattaneo, Davide Biasoni, Mario Catanzaro, Tullio Torelli, Michele Zazzara, Andrea Necchi, Patrizia Giannatempo, Daniele Raggi, Luigi Piva, Maurizio Colecchia, Roberto Salvioni, Silvia Stagni
BACKGROUND: Residual retroperitoneal masses in NSGCT need postchemotherapy retroperitoneal lymph-node dissection (PC-RPLND). Open (O) PC-RPLND is a standardized procedure, but morbidity is not negligible and mostly attributable to laparotomy. Laparoscopic (L) PC-RPLND may improve tolerability profile. We evaluated viability, toxicity, and short to medium-term oncologic outcome of L-PC-RPLND following well-defined selection criteria. PATIENTS AND METHODS: Since February 2011, consecutive patients with a unilateral residual mass (≥1 cm or growing), normalized markers, and limited encasement of inferior vena cava and/or aorta were candidate to unilateral L-PC-RPLND...
October 2016: Journal of Endourology
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...
July 26, 2016: Journal of Robotic Surgery
Joseph Clemons, Whitney E Zahnd, Max Nutt, Dan Sadowski, Danuta Dynda, Shaheen Alanee
PURPOSE: To investigate the impact of rural status and urologist density on the practice of retroperitoneal lymph node dissection (RPLND) and cancer-specific death (CSD) in patients with nonseminomatous germ cell tumor (NSGCT). METHODS: Urologist density was determined from 2014 to 2015 Area Health Resource File data, and rural residence was determined using the 2003 Rural-Urban Continuum Codes. All cases of NSGCT within Surveillance, Epidemiology and End Results (SEER) 18 with known county code were used for analysis (n = 9473)...
July 13, 2016: Journal of Adolescent and Young Adult Oncology
Tyler S Beveridge, Brian L Allman, Marjorie Johnson, Adam Power, Joel Sheinfeld, Nicholas E Power
PURPOSE: Metastatic testis cancer in the retroperitoneum presents a technical challenge to urologists in the primary and post-chemotherapy settings. Where possible, bilateral nerve sparing retroperitoneal lymph node dissection should be performed in an effort to preserve ejaculatory function. However, this is often difficult to achieve, given the complex neurovascular anatomy. To address this we performed what is to our knowledge the first comprehensive examination of the anatomical relationships between the sympathetic nerves of the aortic plexus and the lumbar vessels to facilitate navigation and nerve sparing during bilateral retroperitoneal lymph node dissection...
July 5, 2016: Journal of Urology
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...
June 29, 2016: Urologic Oncology
H Wells, M C Hayes, T O'Brien, S Fowler
OBJECTIVES: To undertake a comprehensive prospective national study of the outcomes of RPLND for testis cancer over a one year period in the United Kingdom. PATIENTS AND METHODS: Data were submitted online using the BAUS Section of Oncology Data and Audit System. All new patients undergoing RPLND for testis cancer between March 2012 and February 2013 were studied prospectively. Data was analysed using Tableau software and case ascertainment compared with Hospital Episode Statistics (HES) data...
June 29, 2016: BJU International
Stanley A Yap, Lindsay M Yuh, Christopher P Evans, Marc A Dall'Era, Rebecca M Wagenaar, Rosemary Cress, Primo N Lara
PURPOSE: To assess the shifting population-level practice patterns across a 20-year time span in the management of stage I non-seminomatous germ cell tumors (NSGCT). METHODS: Using the California Cancer Registry, we reviewed all patients with stage I NSGCT between 1988 and 2010. We determined their primary treatment and their overall rates across the years. Other analyzed variables included patient age, T stage, socioeconomic status, race, and year of diagnosis...
June 15, 2016: World Journal of Urology
Anand Mohapatra, Aaron M Potretzke, Brent A Knight, Min Han, Robert S Figenshau
Granulosa cell tumors (GCTs) of the testis are rare sex cord-stromal tumors that are present in both juvenile and adult subtypes. While most adult GCTs are benign, those that present with distant metastases manifest a grave prognosis. Treatments for aggressive GCTs are not well established. Options that have been employed in previous cases include retroperitoneal lymph node dissection (RPLND), radiation, chemotherapy, or a combination thereof. We describe the case of a 57-year-old man who presented with a painless left testicular mass and painful gynecomastia...
2016: Case Reports in Urology
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...
May 24, 2016: 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...
April 5, 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
Prabhjot Singh, Siddharth Yadav, Sanjay Mahapatra, Amlesh Seth
INTRODUCTION: We aimed to study the outcomes of retroperitoneal lymph node dissection (RPLND) in postchemotherapy residual masses in advanced testicular germ cell tumor (GCT) in the Indian population. PATIENTS AND METHODS: We retrospectively analyzed 35 patients who underwent postchemotherapy RPLND at our institute after primary (29 patients) or salvage (6 patients) chemotherapy over a period of 9 years (June 2003 to July 2012). RESULTS: The mean age of our patients was 26...
January 2016: Indian Journal of Urology: IJU: Journal of the Urological Society of India
Christopher M Russell, Pranav Sharma, Gautum Agarwal, John S Fisher, George J Richard, Philippe E Spiess, Julio M Pow-Sang, Michael A Poch, Wade J Sexton
INTRODUCTION: To evaluate whether varying degrees of seminomatous elements in the primary orchiectomy specimen would be predictive of patient morbidity during post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) since the desmoplastic reaction with seminoma is associated with increased intraoperative complexity. MATERIALS AND METHODS: We retrospectively identified 127 patients who underwent PC-RPLND for residual retroperitoneal masses. Clinicodemographic, intraoperative, and 30 day postoperative outcomes were compared for patients with pure seminoma (SEM), mixed germ cell tumors (GCT) containing seminoma elements (NS+SEM), and tumors with no seminoma elements (NS)...
February 2016: Canadian Journal of Urology
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