Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Retroperitoneal lymph node dissection”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMed1995

The role of retroperitoneal lymphadenectomy in clinical stage B testis cancer: the Indiana University experience (1965 to 1989).

Between 1965 and 1989, 1,180 patients underwent retroperitoneal lymph node dissection for nonseminomatous germ cell testis cancer (638 underwent primary dissection). Of these patients, 174 were considered to have clinical stage B disease preoperatively (suspected retroperitoneal node metastases by clinical staging). Surgery revealed that 41 patients (23%) actually had pathological stage A disease (no cancerous nodes). This nonspecificity in clinical staging remains consistent despite advance in clinical staging methods during this 25-year period. Of the pathological stage B cancer patients 65% were cured by retroperitoneal lymph node dissection alone. These long-term data indicate that primary retroperitoneal lymph node dissection for low stage metastatic nonseminomatous germ cell testis cancer (pathological stage B) not only had diagnostic but also therapeutic impact. Furthermore, this cure rate with long-term followup is equivalent to that of current series of primary chemotherapy alone for stage B disease, which are still relatively early reports. This cure rate with single modality therapy (retroperitoneal lymph node dissection alone) was accomplished within an average of 4 hours and, therefore, should be more time and cost-effective than prior reports of 3 and 4 courses of primary chemotherapy. In the post-cisplatin era (1979 to 1989), 140 patients with clinical stage B disease were treated with primary retroperitoneal lymph node dissection: 32 (23%) had pathological stage A cancer and 2 of them (6%) had relapse. Both patients are currently disease-free with subsequent chemotherapy. Of the remaining 108 patients with pathological stage B disease 49 received no adjuvant chemotherapy and 59 received cisplatin-based adjuvant chemotherapy. Among the former 49 patients 18 (37%) had relapse and 2 died. No patient receiving postoperative cisplatin-based adjuvant chemotherapy had relapse. The overall survival rate in these 140 clinical stage B cancer patients was 98%. There were 3 deaths, only 1 from cancer. The addition of cisplatin-based adjuvant chemotherapy postoperatively has rendered pathological stage B nonseminomatous germ cell testis cancer entirely free of subsequent relapse. Therefore, retroperitoneal lymph node dissection as monotherapy is curative in two-thirds of the patients with stage II disease, while the remaining one-third with progression to clinical relapse can be reliably saved by chemotherapy. Future considerations in selecting therapy for clinical stage II nonseminomatous germ cell testis cancer will be risk-benefit, cost-benefit and quality of life issues. Several cooperative studies will examine these issues, involving European and United States groups.

Chemotherapy, Adjuvant↗
PubMed1992

Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ cell tumors.

For patients with advanced nonseminomatous germ cell tumors a retroperitoneal lymph node dissection is routinely performed following chemotherapy if the serum tumor markers have returned to normal. Bilateral retroperitoneal lymph node dissection has been recommended because metastatic deposits may be widespread. The aim of this study was to describe the distribution of retroperitoneal metastases following chemotherapy in patients with nonseminomatous germ cell tumor and determine if the extent of the retroperitoneal lymph node dissection can be modified. We studied 113 patients who had initially bulky retroperitoneal disease and underwent retroperitoneal lymph node dissection following chemotherapy. For the purposes of this study teratoma and malignant germ cell tumor are referred to as tumor. The most common location of tumor was the para-aortic area (91%) in patients with a left primary tumor and the interaortocaval area (78%) in those with a right tumor. Tumor was located outside the boundaries of a modified retroperitoneal lymph node dissection in 14 of the 60 patients with residual disease but the tumor was present within a palpable mass in 6 of these 14 patients. If the residual mass was removed and a modified retroperitoneal lymph node dissection was performed only 9 of the 113 patients (8%) would have tumor left in the retroperitoneum. For a select group of patients with advanced nonseminomatous germ cell tumor treated with chemotherapy, resection of the residual mass combined with modified retroperitoneal lymph node dissection is appropriate.

Humans↗
PubMed1996

Retroperitoneal laparoscopic lymph node dissection for staging non-seminomatous germ cell tumors before and after chemotherapy.

We describe our experience with laparoscopic retroperitoneal lymph node dissection in 19 patients with non-seminomatous germ cell tumors. Twelve patients had stage I disease with no clinical evidence (CT-scan, ultrasound, tumor markers) of metastases; 7 patients (stage IIb=2, stage IIc=5) had residual tumor after chemotherapy but with negative tumor markers. A laparoscopic dissection was used to asses more fully the pathologic status of the relevant retroperitoneal lymph nodes of both groups. The patient was positioned and trocars introduced at sites similar to that used for transperitoneal laparoscopic nephrectomy (flank position, five ports - 3 x 10 mm; 2 x 5 mm). After reflecting the colon anteromedially, the landmarks of the lymph node dissection were isolated-namely the ureter, aorta, inferior vena cava, and both renal veins. The lymph node dissection included the paracaval, interaorto-caval, upper preaortic, and right common iliac zonal nodes for right-sided tumors, and paraaortic, upper preaortic zones for left-sided tumors. Retrieval of the lymph nodal chains was accomplished using a small organ bag. The mean duration of the procedure was 298 (range 150-405) minutes. In only one patient was a lymph node positive for tumor (stage I). Otherwise nodes showed extensive necrosis (after chemotherapy). No intraoperative complications were encountered but three patients developed a delayed complication (ureteral stenosis, pulmonary embolism, and retrograde ejaculation, respectively). Whereas we completed the dissection in each patient with stage I tumors, the laparoscopic procedure was more difficult in patients with stage II tumors after chemotherapy. In two patients with stage IIb disease laparoscopic lymphadenectomy was successful. In four other patients parts of the dissection had to be done after conversion to an open (conventional) operation using a small incision (suprainguinal or pararectal); in one patient the laparoscopic approach was abandoned and converted to an open operation. In the post-chemotherapy group the outcome depended primarily on the tumor bulk prior to drug treatment. In two patients in whom all residual necrotic tissue was removed laparoscopically they had "minor" disease (stage IIb); the others had stage IIc tumors. Our preliminary experience suggests that a modified laparoscopic lymph node dissection is feasible for stage I tumors and in selected patients with marker negative residual tumor after chemotherapy (stage IIb).

Feasibility Studies↗
PubMed1994

Vascular considerations in postchemotherapy. Retroperitoneal lymph-node dissection: Part II.

A total of 710 patients underwent postchemotherapy retroperitoneal lymph-node dissection (RPLND) from 1965 to 1992. Ten patients, all with bulky disease, required aortic replacement either postoperatively (n = 3) or during RPLND (n = 7). The principal risk factor for aortic rupture after RPLND was an extended subadventitial aortic dissection made necessary by tumor fixation. Also, duodenal enterotomy or extensive violation of the bowel serosa was a further risk for aortoenteric fistula. Prospective aortic grafting may be indicated in the presence of these risk factors. In our four elective cases, there was no further vascular or bowel complication. Omental interposition further protects against fistula formation. Although rarely indicated except under the most extenuating circumstances, the exposure requirements of RPLND permit aortic grafting as a relatively straightforward procedure that is feasible and well tolerated in this small subset of patients.

Aorta↗
PubMed1988

Stage II nonseminomatous germ cell tumors of the testis: an analysis of treatment options in patients with low volume retroperitoneal disease.

The management of patients with nonseminomatous germ cell tumors of the testis and low volume retroperitoneal disease remains controversial. We analyzed the treatment modalities of 56 patients divided into 3 groups: group I--18 clinical stage I cancer patients who had pathological stage II disease after retroperitoneal lymph node dissection, group II--31 patients with abdominopelvic computerized tomography abnormalities of 5 cm. or less with or without positive biological markers and group III--7 patients with persistently positive biological markers after orchiectomy with normal abdominopelvic computerized tomography scans. In group I 4 of 18 patients received chemotherapy after retroperitoneal lymph node dissection. Two patients met criteria for post-dissection chemotherapy, but they did not receive it and subsequently had relapse. Of the remaining 12 patients who were observed after dissection only 1 (8 per cent) had relapse. In group II 19 of 31 patients were treated with initial chemotherapy: 13 (68 per cent) achieved a complete response, while 6 required retroperitoneal lymph node dissection after chemotherapy. Of 31 patients 12 were treated with initial retroperitoneal lymph node dissection and 9 (75 per cent) received post-dissection chemotherapy. In group III 5 of 7 patients were treated with initial retroperitoneal lymph node dissection and 3 of the 5 subsequently required chemotherapy. Of the 7 patients 2 received initial chemotherapy and achieved a complete response. All 56 patients are without disease at 4+ to 106+ months (median 28 months). We conclude that patients with the characteristics of groups II and III should be managed initially with chemotherapy, with retroperitoneal lymph node dissection reserved for patients who fail to achieve a complete response. In group I retroperitoneal lymph node dissection is sufficient initial treatment if pathological evaluation of the retroperitoneal lymph nodes does not meet our criteria for post-dissection adjuvant chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Is post-chemotherapy resection of seminomatous elements associated with higher acute morbidity?

PURPOSE: A seminomatous element in patients undergoing retroperitoneal lymph node dissection for testicular cancer is associated with a desmoplastic reaction that renders retroperitoneal surgery more challenging. We examined the impact of seminomatous elements on the rate of complications and the need for additional intraoperative procedures in patients undergoing post-chemotherapy retroperitoneal lymph node dissection. MATERIALS AND METHODS: The testis cancer data base at our institution was retrospectively reviewed and 1,366 patients were identified who underwent post-chemotherapy retroperitoneal lymph node dissection between 1973 and 2001. In 97 patients there was an element of seminoma in the dissection specimen and/or pure seminoma in the testicular primary specimen (seminoma group). The remaining 1,269 patients underwent post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous testicular tumors. The rates of intraoperative complications and additional procedures as well as postoperative complications were analyzed. RESULTS: Of the 97 patients in the seminoma group 37 (38.1%) required a total of 47 additional intraoperative procedures, including 25 nephrectomies, 9 inferior vena caval resections, 5 arterial grafts, 5 bowel resections and 3 hepatic resections/biopsies, compared with 340 of the 1,269 patients (26.8%) in the group without seminomatous elements (p = 0.02). Postoperatively complications occurred in 24 of 97 patients (24.7%) in the seminoma group versus 257 of 1,269 (20.3%) in the group without seminomatous elements (p = 0.29). One of the 97 patients in the seminoma group died secondary to postoperative complications. CONCLUSIONS: A seminomatous element in patients undergoing post-chemotherapy retroperitoneal lymph node dissection is associated with a higher rate of additional intraoperative procedures and postoperative complications than in patients without seminomatous elements. However, resection is still possible with acceptable morbidity when indicated in appropriately selected patients.

Adolescent↗
PubMed1999

The current role of surgery in the management of residual disease.

The increasing interest in surveillance rather than primary retroperitoneal lymph node dissection for clinical stage I testis cancer has led to retroperitoneal lymph node dissection being performed mostly after chemotherapy for stage II-IV disease. In most centres residual masses of 2-3 cm or more are removed; those smaller than this are most likely to be necrotic. The aim is to remove all residual disease even if this necessitates nephrectomy or excision of adjacent vascular structures. Laparoscopic approaches are hazardous in these circumstances. Thoraco-abdominal surgical approaches enable excellent access to retroperitoneal masses and synchronous excision of ipsilateral pulmonary metastases and thoracic lymph nodes. Retroperitoneal lymph node dissection also appears to be worthwhile in chemotherapy-resistant disease ('desperation retroperitoneal lymph node dissection'), although the relapse rate is higher in this group.

Humans↗
PubMed1994

Unusual neoplasms detected in testis cancer patients undergoing post-chemotherapy retroperitoneal lymphadenectomy.

Approximately 30% of patients with disseminated testis cancer who receive platinum-based chemotherapy will experience normalization of tumor markers but have persistent, radiographically evident disease in the retroperitoneum. These patients usually undergo retroperitoneal lymph node dissection. Of 557 patients undergoing post-chemotherapy retroperitoneal lymph node dissection at our university medical center 45 (8.1%) had neoplastic elements distinct from the classical germ cell tumor types within the resected specimens. Examples include various sarcomas in 19 patients (3.7%), other nonsarcomatous nongerm cell cancers in 18 (3.2%) and cystic atypical choriocarcinoma in 8 (1.4%). No distinct patient characteristics or histological patterns in the primary tumor are predictive of these unusual findings in the retroperitoneal lymph node dissection specimen, although sampling error in the orchiectomy specimen could be the reason for this lack of correlation. Surgical resection of these chemoresistant tumors is potentially curative, with disease-free survival in 13 of 19 patients (68.4%) with sarcoma, 10 of 18 (55.6%) with nonsarcomatous cancer and 7 of 8 (87.5%) with cystic atypical choriocarcinoma at a mean followup of 30.6, 42.5 and 24.7 months, respectively.

Combined Modality Therapy↗
PubMed1997

Residual masses after chemotherapy for metastatic testicular cancer: the clinical implications of the association between retroperitoneal and pulmonary histology. Re-analysis of Histology in Testicular Cancer (ReHiT) Study Group.

PURPOSE: We determined the need and sequence of retroperitoneal lymph node dissection and thoracotomy in patients with nonseminomatous testicular cancer, and with residual retroperitoneal and pulmonary masses after chemotherapy. MATERIALS AND METHODS: We studied 159 patients undergoing retroperitoneal lymph node dissection and a thoracotomy following cisplatin based induction chemotherapy for metastatic testicular nonseminomatous germ cell tumor. Several well-known predictors for residual histology (necrosis, mature teratoma and cancer) were evaluated. RESULTS: As expected, necrosis was found more often at retroperitoneal lymph node dissection if the primary tumor was negative for teratoma, the residual mass was small or the decrease in size was great. Contrary, neither residual mass size nor the decrease in size was predictive of the histological status of the residual lung lesion. Histological findings in the retroperitoneum and lung were strongly correlated, such that necrosis at retroperitoneal lymph node dissection was associated with an 89% probability of necrosis in the lung. CONCLUSIONS: Retroperitoneal lymph node dissection should be performed before thoracotomy is considered, since the histological status at dissection is a strong predictor of that at thoracotomy.

Germinoma↗
PubMed1994

Complications of primary retroperitoneal lymph-node dissection for low-stage testicular cancer.

The surgical complications encountered in 478 patients who underwent primary retroperitoneal lymph-node dissection for clinical stage A and B nonseminomatous testicular cancer during the period ranging from 1982 to 1992 were reviewed. There were 54 complications in 51 patients (10.6%), and there was no surgery-related mortality. There were 16 minor complications and 38 major complications. The most frequent complication encountered was superficial wound infection, and many of the major complications were related to small-bowel obstruction and atelectasis. The incidence of complications was significantly lower in patients operated on during the last 6 years of the study (1987-1992). The complication rate was lower in patients who underwent modified unilateral procedures than in those who had bilateral dissections. The ejaculation rate of patients undergoing nerve-sparing procedures was 98%. This study reinforces the conclusion that primary retroperitoneal lymph-node dissection is an operation yielding minimal morbidity and no long-standing effect.

Ejaculation↗
PubMed2005

Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient.

BACKGROUND AND PURPOSE: The acceptance of open retroperitoneal lymph node dissection (RPLND) for stage I and II nonseminomatous testicular cancer has decreased because of the intraoperative and postoperative morbidity of the procedure. Laparoscopic RPLND is a minimally invasive and safe alternative for low-stage germ-cell tumors. It is, however, technically demanding and should therefore be performed only in experienced centers. The purpose of the present study was to evaluate the waterjet technique for laparoscopic RPLND. PATIENTS AND METHODS: A series of 18 patients with clinical stage I testis cancer (group A) and 7 patients who had received chemotherapy for stage II disease (group B) underwent laparoscopic RPLND at our institution. The procedure was performed identically to the open approach using the modified template according to Weissbach and associates. The waterjet was used for removal of lymphatic tissue from the aorta and the vena cava, as well as from the sympathetic trunk. RESULTS: The operation was completed in all patients without conversion to open surgery. The mean operating time was 232 +/- 48 minutes. The waterjet was able to remove lymphatic tissue easily and atraumatically. At pressures of 20 bar, the lymph-node capsule remained completely intact, thus avoiding tumor-cell spread. Antegrade ejaculation could be preserved in all patients, who, to date, show no evidence of disease. CONCLUSIONS: The waterjet allows the safe and complete removal of lymphatic tissue, leaving vulnerable anatomic structures intact. It can decrease the learning curve of laparoscopic RPLND and contribute to better acceptance of this procedure.

Adult↗
PubMed2002

Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in post-chemotherapy nonseminomatous testis cancer.

PURPOSE: Patients who require post-chemotherapy retroperitoneal lymph node dissection after induction chemotherapy for metastatic testis cancer derive therapeutic benefit from resection of teratoma but resection of necrosis is not beneficial. We determine if the absence of teratoma in the orchiectomy specimen is a reliable predictor of the absence of teratoma in the retroperitoneum at post-chemotherapy retroperitoneal lymph node dissection. MATERIALS AND METHODS: A retrospective review of the Indiana University testis cancer data base was performed. A total of 644 patients who underwent retroperitoneal lymph node dissection after induction chemotherapy only were selected for study. The presence or absence of teratoma in the orchiectomy specimen and volume of retroperitoneal tumor were analyzed as predictors of retroperitoneal teratoma at post-chemotherapy retroperitoneal lymph node dissection. RESULTS: Of the patients with teratoma in the orchiectomy specimen 85.6% had an element of teratoma in the retroperitoneum, and of those without teratomatous elements in the orchiectomy specimen 48% had teratoma in the retroperitoneum (p <0.00001). Increasing volumes of retroperitoneal tumor were associated with a higher probability of discovering teratoma at post-chemotherapy retroperitoneal lymph node dissection. CONCLUSIONS: The absence of teratoma in the orchiectomy specimen does not reliably predict the absence of teratoma in the surgical specimen at post-chemotherapy retroperitoneal lymph node dissection. Post-chemotherapy surgery is indicated if retroperitoneal tumor remains after chemotherapy irrespective of the presence or absence of teratoma in the orchiectomy specimen.

Chemotherapy, Adjuvant↗
PubMed1998

Vascular interventions during post-chemotherapy retroperitoneal lymph-node dissection for metastatic testis cancer.

AIMS: Complete excision of nodal masses during post-chemotherapy retroperitoneal lymph-node dissection (RPLND) for metastatic non-seminomatous germ-cell tumours (NSGCT) of the testis often requires vascular surgical intervention. We report our experience of vascular interventions and complications in a large series of men undergoing postchemotherapy RPLND. METHODS: A retrospective review of vascular interventions during post-chemotherapy RPLND in 98 patients was undertaken (103 procedures). RESULTS: Macroscopic tumour clearance was complete in 95/98 men (97%). Vascular intervention was required in all cases. Major complications included acute tubular necrosis in one patient who had undergone left nephrectomy and extensive dissection around the right renal artery, progressive atrophy of the ipsilateral kidney in three men and a colonic stricture and associated colocutaneous fistula in one patient after division of the inferior mesenteric artery. Iliac and femoral venous thrombosis developed in both patients in whom the inferior vena cava (IVC) was excised and in one patient after partial IVC excision. Eight of the 98 patients have died. No late vascular complications have occurred to date. CONCLUSION: Complete tumour clearance can be achieved in most post-chemotherapy RPLNDs but invariably involves vascular intervention. Metastatic NSGCT should be treated by surgeons with the ability to undertake the vascular procedures required.

Adolescent↗
PubMed1991

Is adjuvant chemotherapy necessary for patients with stage B1 testicular cancer?

Controversy exists concerning the role of adjunctive chemotherapy in patients with regional nodal involvement. A randomized study reported a 48% relapse rate for patients with positive nodes (stage B1 or stage B2), all of whom were salvaged by full-dose platinum-based chemotherapy. In a series of patients with positive nodes who received two cycles of adjunctive chemotherapy postoperatively, the relapse rate was only 2%. In order to evaluate the effect of retroperitoneal lymph node dissection on relapse rates in patients with stage B1 testicular cancer, a retrospective review of a series of 39 patients was performed. Criteria for inclusion included pathologic stage B1 (less than six positive nodes, located in the primary landing site, with no node greater than 2 cm in diameter and no extracapsular lymph node extension). Patients who fulfilled the criteria along with normalization of tumor markers were followed-up expectantly after retroperitoneal lymph node dissection. Thirty-nine patients were followed from 1 to 10 years with the median duration of follow-up of 3.5 years. Ten of the 39 patients had modified retroperitoneal lymph node dissections with preservation of antegrade ejaculation. The other 29 had full retroperitoneal lymph node dissections. Three relapses were seen, one patient with retrocrural and pulmonary metastases and two patients with pulmonary metastases only for a relapse rate of 8% (three of 39). Patients with stage B2 disease received adjunctive chemotherapy with two or three cycles of platinum-based chemotherapy. We conclude that retroperitoneal lymph node dissection alone is adequate treatment for the majority of patients with pathologic stage B1 testicular cancer. In that subset of patients, adjunctive chemotherapy should be reserved for relapse.

Cisplatin↗
PubMed1976

Non-seminomatous testis tumors: a plan of management based in 96 patients to improve survival in all stages by combine therapeutic modalities.

To develop a plan of management based on the clinical and pathologic stage of the tumor the results of treatment of 96 consecutive patients with non-seminomatous testis tumors have been analyzed. There were no exclusions and all patients were treated, including 17 with advanced stage C disease. All patients underwent retroperitoneal lymph node dissection as primary treatment but the judicious use of adjuvant therapeutic modalities improved survival in all stages of disease. Chemotherapy was the most important adjuvant and postoperative radiation therapy was reserved for patients with extensive retroperitoneal metastatic disease. Results indicate that a modified unilateral thoracoabdominal retroperitoneal lymph node dissection can effectively remove the retroperitoneal nodes. Of 57 patients 50 with stage A or B tumor survived after lymph node dissection without radiation therapy. Compared to an operation alone prophylactic adjuvant chemotherapy improved survival from 82 to 93 per cent for patients with minimal disease (stage A or B1). Postoperative irradiation therapy combined with cyclic chemotherapy improved survival for patients with advanced retroperitoneal disease compared to an operation and radiation alone or an operation and chemotherapy alone. An aggressive approach that combined operation with chemotherapy, radiation therapy or both, has salvaged 8 of 17 patients with disseminated metastatic disease (stage C). The over-all survival rate for these 96 patients is 78 per cent. A plan of management has evolved, which is based on retroperitoneal lymph node dissection followed by the judicious use of adjuvant chemotherapy and radiation therapy as determined by pathologic findings.

Choriocarcinoma↗
PubMedDate not supplied

Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer.

BACKGROUND AND PURPOSE: Laparoscopic retroperitoneal lymph-node dissection (RPLND) has been advocated for and utilized in the management of testicular cancer. In this overview, we present our technique and results in comparison with the worldwide experience with laparoscopic RPLND in the management of clinical stage I and II cancers. PATIENTS AND METHODS: Over the last 13 years, 162 patients with testicular cancer clinical stage I (N = 103) or II (N = 43 IIB, 16 IIC) underwent laparoscopic RPLND. All intraoperative and postoperative data were evaluated, as well as the worldwide experience with the procedure. With a mean follow-up of 62 months (range 6-113 months) for clinical stage I and 53 months (range 10-89 months) for clinical stage II, oncologic efficiency was evaluated. RESULTS: The procedure was feasible even after chemotherapy, with only three conversions to open RPLND in clinical stage I. The mean operative time was 217, 216, and 281 minutes for clinical stages I, IIB, and IIC, respectively. The mean blood loss was 144 mL and 165 mL for clinical stage I and II, respectively. The hospital stays were 3.6 and 3.8 days, respectively. During follow-up, we had two retroperitoneal relapses (1.2%) and four distant relapses (2.5%). CONCLUSION: Laparoscopic RPLND has demonstrated its surgical and oncologic efficacy. The morbidity and the complication rate are low. Recurrence rates are comparable to those of open surgery. Laparoscopic RPLND is safe, with less postoperative morbidity, quicker convalescence, better cosmetic results, and a diagnostic accuracy equal that of the open technique.

Adolescent↗
PubMed1989

Management of yolk sac carcinoma of the testis clinical stage I: lymphadenectomy vs. no lymphadenectomy.

Thirty seven patients with Stage I yolk sac tumor of the testis were registered at the Instituto Nacional de Enfermedades Neoplasicas (I.N.E.N.), Lima-Peru from 1962 through 1980. Eighteen patients underwent retroperitoneal Lymph node dissection. The age incidence was 5 to 29 months except for two patients 50 and 84 months of age each. Bilateral retroperitoneal lymph node dissection was performed in seventeen patients; unilateral dissection was performed in one patient. In two patients both had one positive node at lymphadenectomy (2/18: 11%). Eleven patients (61.11%) are alive and with no evidence of disease in between 7 to 26 years post lymphadenectomy. Seven patients (38.89%) died: 4/18 (22.22%) because of progression of the disease and three patients because of no neoplastic cause. Nineteen patients did not have retroperitoneal lymph node dissection: seven patients (36.84%) are alive with no evidence of disease and 12 patients (63.16%) died: 8/19 (42.10%) because of progression of the disease and 4/19 (21%) with no neoplastic disease. In conclusion, patients with localized disease (Clinical Stage I) benefit from retroperitoneal lymph node dissection when compared to a similar group of patients not submitted to lymphadenectomy.

Child, Preschool↗
PubMed1987

Localization of solitary and multiple metastases in stage II nonseminomatous testis tumor as basis for a modified staging lymph node dissection in stage I.

Because of a continuing need for pathological staging of clinical stage I testicular tumors an investigation was performed to determine the primary sites of metastatic involvement of the retroperitoneal lymph nodes and to define narrowly limited ipsilateral areas of lymph node dissection strictly for the purpose of staging. Surgical/pathological localization of solitary metastases provides the most direct evidence of primary lymphatic spread. There were 214 consecutive patients with stage II disease (excluding bulky disease) evaluated with respect to localization relative to the side of the involved testis and the number of metastases up to 5 cm. Solitary metastases of 5 cm. or less were found in 74 patients, 53 patients had 5 or less lymph nodes of 2 cm. or less and 87 patients had more than 5 lymph nodes of between 2 and 5 cm. Solitary nodes of the right testis tumor were located with decreasing frequency in the upper and lower interaortocaval, lower paracaval and precaval, upper precaval and right common iliac, upper paracaval and upper preaortic zones. Primary deposits of the left testis tumor were seen predominantly in the upper para-aortic zone. Upper preaortic and lower para-aortic zones were involved infrequently, and other areas were affected only in rare cases. These data contradict the assumption of a testicular lymph center located at the openings of the testicular veins into the vena cava and left renal vein, respectively. Multiple metastases were spread over the entire retroperitoneum, except for the external iliac regions. Hilar/suprahilar metastases were seen infrequently. Ipsilateral areas are defined according to primary involvement. A modified retroperitoneal lymph node dissection within ipsilateral areas is proposed as a staging operation for clinical stage I disease and a radical retroperitoneal lymph node dissection is indicated for pathological stage II disease.

Humans↗