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PubMedDate not supplied

[Controlled pilot study with combination chemotherapy in testicular carcinomas (author's transl)].

In 24 previously untreated patients with advanced testicular carcinoma, the combination of adriamycin, vincristine and methotrexate (AVM) was tested in a prospective randomized study against a combination of non-cross resistant drugs including vinblastine, bleomycin and mithramycin (VBM). Complete and partial (greater than 50%) remission was observed in 4 out of 13 patients treated with AVM and in 3 out of 11 given VBM. In one patient receiving AVM and in two patients treated with VBM, the response at the level of previous inoperable retroperitoneal metastatic lymph nodes allowed a subsequent radical lymph node dissection. After cross-over a partial response for 6 months was obtained in only one patient treated with VBM while none was observed in 4 patients receiving AVM. Both combinations were well tolerated. However, their therapeutic activity seems to be definitely lower with respect to treatment with vinblastine followed by continuous infusion with bleomycin.

Antineoplastic Agents↗
PubMed1989

Massive lymphocele following pelvic lymphadenectomy for staging of prostatic cancer.

Two patients developed massive pelvic lymphoceles within 30 days of retroperitoneal node dissection for staging of prostatic cancer. Excised lymph nodes were negative for metastases. Both patients developed severe bilateral peripheral edema, and one developed pulmonary thromboembolism from intraluminal thrombi in the adjacent, compressed inferior vena cava. Each patient responded to unroofing of the cyst wall with either concomitant external or internal drainage.

Aged↗
PubMed1999

[Retroperitoneal sarcomas: 1. Natural history and preoperative evaluation].

The disease is usually disseminated via the blood stream. These large tumors displace adjacent organs and are usually close to vital structures. High rate of local or peritoneal recurrence may be explained by resection problems. Local recurrence is the most frequent cause of patient death. No adjuvant treatment has proved to be beneficial on survival. Diffusion of the disease is usually hematogenous. Hepatic and pulmonary metastases are the most common, while lymph node invasion is very rare. This account for no systematic lymph node dissection in these tumors. Preoperative biopsy through a retroperitoneal route under CT scan vision is advised, before operation. NMR and CT scan are the best tools to assess extension of tumor through anatomical structures. Quality of surgical resection is the main factor which determine prognosis in term of local or peritoneal recurrence risk. This risk is best evaluated by pathological examination which must determine whether the specimen is or not complete.

Biopsy↗
PubMed1992

Role of lymphadenectomy in renal cell carcinoma.

A retrospective analysis of 97 consecutive patients with renal cell carcinoma, observed between 1983 and 1989, was performed. All patients underwent radical nephrectomy followed by extensive retroperitoneal lymphadenectomy which included hilar, laterocaval/lateroaortic, and interaortocaval lymph node dissection. Lymph nodes and distant metastasis accounted for 6.2% and 7.2% of the cases respectively. A statistically significant correlation between the stage and the grade of the tumor and the frequency of lymph nodes (p < 0.01) and distant metastases (p < 0.05) was found. In patients with no lymph nodes or distant metastases, the 5-year survival rate was 100%, 79%, 68%, and 50% for stage T1, T2, T3, and T4 respectively. No statistical difference in survival between stage T1, T2, and T3 was found. The size and histological grade of the tumor significantly affected the survival rate at 5 years. In fact, < 5 cm, 5-10 cm, and > 10 cm tumors had 93%, 52%, and 65% survival rates respectively, while G1, G2, and G3 tumors had 75%, 68%, and 21% survival rates respectively. In patients with nodal metastases and distant metastases the 5-year survival rate was 25% and 0%. Survival appears to be significantly influenced by the presence of lymph node and distant metastases, while retroperitoneal lymphadenectomy does not improve the survival of patients with lymph node metastases.

Adult↗
PubMed1997

[Changes in lymph node dissection for pancreatic cancer].

Two step pancreatoduodenectomy for periampullary carcinoma was first reported in 1912 by Kausch. Pancreatoduodenectomy performed for carcinoma of the head of the pancreas was first reported in 1937 by Brunschwig. Before this report, all previous pancreatoduodenectomy had been performed for other periampullary tumors. By the 1960's, pancreatoduodenectomy was performed for pancreatic cancer without lymph node dissection. However, Fortner advocated regional pancreatectomy for pancreatic cancer in 1973. In our institute, also, extended radical pancreatectomy by translateral retroperitoneal approach has been performed during the past 2 decades. Many Japanese surgeons also adopted extend pancreatectomy. In the 1980's, extended radical pancreatectomy consisted of paraaortic lymph node dissection, total pancreatectomy, and complete resection of extrapancreatic nerve plexus. However, based on the many clinicopathologic studies, pancreatoduodenectomy was better operative procedure than total pancreatectomy. Although extended radical pancreatectomy has the advantage of long-time survival, disadvantage of nutritional status and quality of life was produced by this operative procedure. Tarverso and Longmire reported new operative procedure of pylorus preserving pancreatoduodenectomy (PPPD) in 1978. Recently, this operative procedure was indicated for pancreatic cancer. However, there is a question whether PPPD is the best operative procedure for pancreatic cancer or not.

Humans↗
PubMed1995

Experimental retroperitoneal endoscopic surgery.

Techniques for retroperitoneal endoscopic procedures with the patient in prone position were evaluated in experimental studies in the pig. Nephrectomy, para-aortic lymph node dissection, lumbar sympathectomy and assisted aorto-femoral bypass were performed and the experience is reported herein. The prone position contributes to the creation of the retroperitoneal working space and eliminates the need for extensive retraction and thus for additional ports. The modified open Hasson technique was found to be the preferred retroperitoneal access procedure.

Animals↗
PubMed1995

Noninsufflative laparoscopic access.

Standard laparoscopic surgery requires maintenance of the working cavity by continual carbon dioxide insufflation and exaggerated Trendelenburg positioning. Both cardiopulmonary and metabolic adverse effects may result from these maneuvers, which may be avoided by a gasless approach to laparoscopic surgery. We investigated a new mechanical retraction system designed to maintain exposure of either intraperitoneal or retroperitoneal contents in a gasless laparoscopic cavity and assessed its performance in both laparoscopic approaches. Gasless laparoscopic surgery was attempted using the Laprolift/Laparofan system for retroperitoneal procedures: left varicocele ligation (three cases), renal biopsy (one case), extraperitoneal pelvic lymph node dissection (one case), and intraperitoneal bilateral varicocelectomy (two cases). Renal biopsy and varicocelectomy were accomplished successfully with the gasless approach and with technical ease comparable to that of the standard insufflative laparoscopic approach. Gasless pelvic lymph node dissection and intraperitoneal varicocelectomy were converted to insufflative laparoscopic or open procedures because of inadequate exposure of the pelvic contents. This early experience with gasless laparoscopy indicates that it may best be reserved for retroperitoneal urologic procedures.

Biomechanical Phenomena↗
PubMed2006

Usefulness of positron emission tomography (PET) in a retroperitoneal primary non-seminomatous germ cell tumor: a case report.

A 32-year-old Japanese man was admitted complaining of palindromic fever and abdominal pain. Computed tomography (CT) revealed retroperitoneal mass and positron emission tomography (PET) demonstrated massive radiotracer uptake in this tumor. Serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) were 4,760 ng/ml, 6,000 mIU/ml, respectively. Biopsy specimen from the tumor showed non-seminomatous germ cell tumor. The International Germ Cell Cancer Collaborative Group (IGCCCG) staging system indicated this case as an intermediate prognosis group. After three cycles of bleomycin, etoposide and cisplatin (BEP) therapy, CT revealed a degenerated residual mass. Serum levels of tumor markers were normalized completely and PET showed no radiotracer uptake in the retroperitoneal lesion. Although he did not receive further chemotherapy and lymph nodes were not dissected, he was free of disease for two years.

Adult↗
PubMed2001

Future developments and perspectives in laparoscopy.

INTRODUCTION: As urologists head into the new millennium, it has become clear that laparoscopy will play a significant role in successful urologic practice. Issues that are addressed in this article include: (1) What are the new limits? (2) Technological advances. (3) Adequate training. (4) How to technically simplify the laparoscopic procedures? MATERIALS AND METHODS: To answer the stated questions a review of the literature has been undertaken together with interviews of the leading experts and laparoscopic working groups in urologic laparoscopy. The gathered information has been summarized and focussed with the aim of presenting the perspectives of laparoscopy in urology. RESULTS AND DISCUSSION: Standardized indications for laparoscopic urological surgery are benign nephrectomy, nephroureterectomy, cryptorchidism, adrenalectomy, renal cysts, lymphocele and bilateral or relapsing varicocele. Future indications might include living donor nephrectomy, partial nephrectomy and cyst decortication for adult polycystic kidney disease. Controversy exists about the laparoscopic treatment of malignancies in the urinary tract. Whereas pelvic lymph node dissection--even if performed with decreasing frequency--is accepted worldwide, retroperitoneal lymphadenectomy for low-stage testis cancer is currently performed only at few centers. The recent breakthrough in uro-oncological laparoscopic surgery has been laparoscopic radical prostatectomy changing our views on the limits of laparoscopic urology. Endoscopic suturing devices (i.e. Endostitch) are further being developed, and a prototype reapproximating micro-clips (VCS stapler) has been used to perform a uretero-ureterostomy laparoscopically in a porcine model. Nevertheless, the ability of endoscopic suturing using the standard equipment has still to be considered as a "conditio sine qua non". Improvements for tissue division and dissection include an electrosurgical snare to perform a partial nephrectomy, the development of a pneumodissector and hydrodissector. Robotics, including the AESOP 3000 and ZEUS represent a glimpse of the future. By positioning the optique in a voice-controlled full range motion mechanic arm, the image on the screen is very steady and the ergonomics of the surgeons is increased significantly. The da Vinci-System, however, is the first system that has translated all visions of telepresence surgery into clinical reality, recently also for laparoscopic radical prostatectomy. CONCLUSIONS: The future of laparoscopic urology is a two-tiered approach. On the first tier, the advancement of complex reconstructive and ablative surgery such as laparoscopic prostatectomy or, laparoscopic retroperitoneal node dissection, will be undertaken by referral centers of expertise. It is from these individuals that we will look to in order to separate what is feasible and what is reasonable. The second tier will be focusing on simplifying the procedure for the average urologist. As such, developments such as the pneumodissector, hydrodissection, and hand assistance will bring exstirpative laparoscopy into the realm of more urologists. What is critical is that the urologic community supports both groups of laparoscopists.

Education, Medical, Graduate↗
PubMed1992

[Chylothorax and chylous ascites following surgery of an inflammatory aortic aneurysm. Case report with review of the literature].

Chylous ascites complicating surgery on the abdominal aorta is infrequent: we report one case associated with right chylothorax, secondary to the surgical cure of an inflammatory aortic aneurysm. Surgery for aneurysms causes 81% of all chylous ascites caused by injuries to the intestinal lymphatics or to their recipients, the left latero-aortic lymph nodes or the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the major etiological factors. Stasis and fibrosis, then the rupture of the lymphatics into the aneurysmal wall were described during inflammatory aneurysm: this lymphatic etiology might explain the inflammatory character of these aneurysms and entail a risk of lymphoperitoneal fistula when laying the aneurysmal wall flat. An early diagnosis must be established with paracentesis before any compressive, metabolic, immunological or septic complications occur. Continuous parenteral feeding and selective paracenteses dry out 80% of the postoperative chylous ascites. If the ascites persists after 4 to 6 week's conservative treatment, a peritoneojugular derivation or a direct lymphostasis may be contemplated, according to the patient's condition.

Aorta, Abdominal↗
PubMed1998

Pancreatic surgery: cutting-edge developments and technology.

In the 1980s, Japanese pancreatic surgeons used aggressive strategies to treat pancreatic cancer under the influence of Fortner's regional pancreatectomy and developed several surgical approaches including extended lymph node and connective tissue clearance with autonomic nerve dissection around the celiac and superior mesenteric arteries. Nagakawa's "translateral retroperitoneal approach" in extended radical pancreatectomy was accepted and used by many Japanese surgeons; however, whereas this operation prolonged postoperative survival, it also induced high rates of postoperative complications and ultimately failed to improve the quality of the patient's life. A pylorus-preserving pancreatoduodenectomy with modified extended dissection of the lymph node and connective tissues did not decrease the survival rate for resected patients but improved their quality of life. In the next decade, Takada developed duodenum-preserving total pancreatic head resection, which preserves the integrity of the digestive and biliary tracts. This operation, to anastomose the main pancreatic duct with the duodenum, is unique and is applicable to benign or low-grade malignant lesions of the pancreas. Adjuvant treatments have not offered satisfactory results as expected. Finally, it is recommended that the aggressive Japanese surgical strategies be reevaluated in a formal trial with a prospective randomized study to improve the quality and longevity of the patients' lives.

Humans↗
PubMed1986

Sequential excision of residual thoracic and retroperitoneal masses after chemotherapy for stage III germ cell tumors.

Twenty-three patients with advanced (Stage III) mixed germ cell tumors underwent laparotomy and thoracotomy or neck dissection for excision of persistent radiographic masses after systemic chemotherapy. In those who received multidrug regimens incorporating high-dose cisplatin, 4 of 15 (27%) harbored persistent tumor in at least one site, 6 of 15 (40%) demonstrated necrotic tumor or fibrosis only in all sites examined, and the remaining 5 of 15 (33%) harbored mature teratoma in at least one area. In patients treated with high-dose platinum chemotherapy regimens 11 of 15 (73%) remain disease-free with a median follow-up period of 29 months (range, 1-58 months). Histologic comparison of tissues resected during thoracotomy and retroperitoneal node dissection indicated that patterns were dissimilar in 8 of 23 patients (35%). These data indicate the favorable impact of combined sequential chemotherapy and surgery in patients with advanced mixed germ cell tumors. In patients with Stage III tumors, persistent radiographic disease after cyclic cisplatin-based chemotherapy is appropriately managed by excision of both thoracic and retroperitoneal deposits.

Adolescent↗
PubMed1999

Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study.

OBJECTIVES: Pelvic lymph node dissection as part of the staging surgery for cervical carcinoma interrupts the afferent lymphatics, so the lymph drains retroperitoneally. New surgical techniques designed to leave the peritoneum open after the retroperitoneal dissection, in particular the application of a pedicled omentoplasty along the dissection route, have been advocated to prevent the formation of lymphocysts and lymphedema. We investigated the possible benefit of pedicled omentoplasty in preventing lymphocysts and lymphedema following pelvic lymph node dissection. METHODS: In this pilot study with historical controls we compared the formation of lymphocysts and lymphedema following two different surgical techniques for pelvic node dissection: group I (historical controls), in which the dorsal peritoneum was left open, and group II, in which the dorsal peritoneum was left open with application of a pedicled omentoplasty. In these two groups of gynecologic patients, we compared the lymph flow patterns and the occurrence of lymphedema following systemic pelvic lymphadenectomy. The two groups were of comparable clinical status and consisted of 12 (group I) and 10 (group II) patients. Lymphocysts, if any, were detected by CT scan, the lymph flow patterns were visualized by dynamic lymphscintography, and lymphedema was visualized by physical examination and magnetic resonance imaging of the groin and the upper leg. RESULTS: In both groups a distinct intraperitoneal absorption of the lymph fluid was observed. Pedicled omentoplasty seemed to facilitate the absorption or transport of lymph fluid, resulting in less lymphedema in the upper leg. CONCLUSION: It appeared that leaving the dorsal peritoneum open to give the lymph stream the opportunity to pour into the abdominal cavity is important in preventing lymphocysts and lymphedema. The dynamic lymphscintigraphy described in this paper showed that the intraabdominal lymph flow is absorbed by the peritoneum and even more quickly by the pedicled omentum.

Adult↗
PubMed1994

Controlled balloon dilatation of the extraperitoneal space for laparoscopic urologic surgery.

Laparoscopic urologic surgery has become increasingly more popular, with the majority of procedures and techniques that have been described based on intraperitoneal experience and anatomic considerations. Urologic surgery, traditionally confined mostly to the extraperitoneal space, has followed these intraperitoneal descriptions when undertaken laparoscopically. Our experience of controlled, laparoscopically monitored dilatation of the extraperitoneal space using a new trocar-mounted balloon dissector can create a working space in a surgical environment familiar to traditional open urologic surgery. We report our initial experience with the preperitoneal distention balloon in 15 patients, emphasizing the technique of extraperitoneal access and the laparoscopic visualization of anatomy relevant to pelvic lymph node dissection, varicocele ligation, nephropexy, and renal biopsy. In this early experience, laparoscopic pelvic lymph node dissection was performed successfully in 7 of 11 patients and in all other patients undergoing the retroperitoneal procedures. Patients with a prior history of hernia repair or appendectomy do not appear to be suitable to this approach when used for pelvic lymphadenectomy. The trocar-mounted balloon device allows direct visualization and control of the dissection process. Avoiding the transperitoneal approach may eliminate many of the complications associated with the transperitoneal access and procedure completion. We conclude that the extraperitoneal technique using this device merits further investigation and more widespread application in the laparoscopic approach to conventional extraperitoneal urologic procedures.

Biopsy↗