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Results for “Retroperitoneal lymph node dissection”

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At least 19 recordsLinked to original sources
PubMed1992

Major vessel excision in retroperitoneal lymph node dissection.

Retroperitoneal malignant tumours, both primary and metastatic, may involve surrounding structures such as the aorta and vena cava, making complete tumour excision difficult. En bloc resection of major blood vessels should be considered in such cases. The authors describe three patients who underwent excision of major blood vessels with retroperitoneal lymph node dissection. Two patients had aortic resection with placement of a Dacron tube graft, and one had excision of the vena cava from above the renal vessels to the level of the common iliac veins with distal venous ligation. The low complication rate confirms the feasibility of excising major blood vessels to accomplish complete retroperitoneal lymphadenectomy.

Adolescent↗
PubMed1989

Small bowel intussusception: an unusual complication of retroperitoneal lymph node dissection.

Modified bilateral retroperitoneal lymph node dissection is used widely in the staging and treatment of patients with nonseminomatous germ cell testis tumors. Complications are uncommon and include vascular injury, infertility and small bowel obstruction from fibrous adhesions. Small bowel intussusception following retroperitoneal lymph node dissection has not been reported previously. We report 2 cases of small bowel intussusception after retroperitoneal lymph node dissection, and discuss the etiology and possible preventive measures.

Adult↗
PubMed1988

Complications of retroperitoneal lymph node dissection.

In summary, the complications of retroperitoneal lymph node dissection for low-stage testis cancer appear to be minimal, especially with the advent of nerve sparing techniques. However, the approximate 30 per cent of patients who require primary chemotherapy and do not attain a complete remission are candiates for postchemotherapy retroperitoneal lymphadenectomy, and these patients are subject to a higher risk of intraoperative and postoperative complications. Maintaining awareness of these potential complications may aid in preventing morbidity in this group of patients.

Humans↗
PubMed1977

Changes in the lymphatic dynamics after retroperitoneal lymph node dissection.

Lymphatic dynamics in the retroperitoneal space are altered after retroperitoneal lymph node dissection. Obstruction with or without visible collaterals is seen frequently. Lymphaticovenous communications and lymphocysts are also common findings. The immediate sequelae are of minor importance, although the mass effect of lymphocysts may be serious. The collateral pathways and lymphaticovenous anastomoses may result in the appearance of metastases in unusual sites.

Adolescent↗
PubMed1987

Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer.

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.

Adult↗
PubMed1985

The question of retroperitoneal lymph node dissection for clinical stage I non-seminomatous testis tumors.

Fifty retroperitoneal lymph node dissection (RPLND) performed by the same surgeon on 45 clinical stage I and in 5 clinical stage II cases of non seminomatous testis tumors were reviewed. Of the 45 clinical stage I patients, 12 revealed retroperitoneal lymph node involvement. Of the 17 stage II cases, one survived for more than 4 years and 3 for more than 6 years with no other treatment. There was no evidence of recurrence. Eight patients with no other treatment died within one year and a half of RPLND. Five patients, some with gross nodal disease are alive with no evidence of recurrence after RPLND and chemotherapy (PVB) (Einhorn, Donohue 1977). Of the 50 patients, only two preserved ejaculation. The author questions the systematic use of RPLND in clinical stage I testis tumors. In view of the improvement of chemotherapy agents, he favors the option of careful surveillance of these patients, who should benefit from chemotherapy and eventually surgical resection according to the progress of the disease.

Ejaculation↗
PubMed1991

Patient selection for retroperitoneal lymph node dissection after chemotherapy for nonseminomatous germ cell tumors.

The indications for retroperitoneal lymph node dissection (RPLND) after chemotherapy for nonseminomatous germ cell tumor of the testis vary widely. We reviewed our experience with 122 patients who underwent RPLND within 6 months of receiving cisplatin-based chemotherapy for bulky (greater than 3 cm) retroperitoneal metastases. Pathologic findings were necrotic tissue in 57 (47%), teratoma in 48 (39%), and residual malignancy in 17 (14%). The size of the retroperitoneal mass after chemotherapy (p = 0.001) and the degree of shrinkage that occurred with chemotherapy (p = 0.0001) were both strongly correlated with the histologic findings at RPLND. The presence or absence of teratomatous elements in the pretreatment orchiectomy specimens was only weakly correlated (p = 0.06). Multivariate logistic regression found shrinkage and the size of the residual mass to be independent predictors of finding only necrotic tissue. We were unable to identify preoperatively a group of patients in which some did not have teratoma or malignancy ultimately resected. Of 39 patients who had a residual mass less than 1.5 cm, and 43 patients whose residual mass was less than 1.5 cm or whose mass had shrunk by greater than 90%, 3 had residual malignancy, and 5 had teratoma resected. Among these 8 patients, 7 had prechemotherapy masses greater than 3 cm. Even with stricter criteria, of 17 patients with no testis teratoma initially and a residual mass less than 1.5 cm which had shrunk by greater than 90%, 5 (30%) had teratoma or malignancy resected. Postchemotherapy RPLND is recommended for all patients with a prechemotherapy mass greater than or equal to 3 cm, irrespective of the radiographic findings.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Selection of testicular tumor patients for omission of retroperitoneal lymph node dissection.

Excluding patients with bulky stages II or III disease, 73 patients with nonseminomatous germ cell testicular tumors were evaluated between September 1979 and April 1983 for a protocol omitting retroperitoneal lymph node dissection. Patient eligibility required clinical stage I (T1 category) disease based upon normal post-orchiectomy serum tumor markers (alpha-fetoprotein, human chorionic gonadotropin and lactic dehydrogenase), chest x-ray, ipsilateral lymphangiography, and a computerized tomography scan of the abdomen and pelvis. Of the 73 patients 10 (14 per cent) were entered and followed for more than 2 years (3 had relapse within 7 months but were salvaged with retroperitoneal lymph node dissection and chemotherapy). Analysis of failures showed embryonal carcinoma in all 3 patients, with vascular invasion in the primary tumor in 1 and undetected spermatic cord involvement in 1, while 1 had a slower than expected decrease to normal of an elevated human chorionic gonadotropin level after orchiectomy. There were 63 patients (86 per cent) excluded from the protocol for various reasons: 2 (3 per cent) refused treatment, 16 (25 per cent) had suspicious or positive lymphangiography, 22 (40 per cent) had a positive CT scan, 6 (9 per cent) had elevated tumor markers, 3 (5 per cent) were less than 15 or more than 15 or more than 40 years old, 8 (13 per cent) had had a prior orchiopexy or scrotal violation, 4 (6 per cent) had extension to the spermatic cord and 2 (3 per cent) were unavailable for monthly followup. These 63 patients underwent retroperitoneal lymph node dissection, and 36 (57 per cent) had negative and 27 (43 per cent) had positive nodes (8 had stage N1, 10 stage N2A, 6 stage N2B and 3 stage N3 disease). Average interval from orchiectomy to final staging was 6 weeks. The results suggest that assessment of local tumor extent and potential sites of metastases via all available means are necessary in an effort to reduce the risk of tumor recurrence in patients who are followed expectantly.

Adolescent↗
PubMed1991

Resection of the inferior vena cava or intraluminal vena caval tumor thrombectomy during retroperitoneal lymph node dissection for metastatic germ cell cancer: indications and results.

A total of 42 patients underwent inferior vena caval resection (40) or intraluminal tumor thrombectomy (2) during retroperitoneal lymph node dissection for bulky abdominal metastatic nonseminomatous germ cell cancer (7% of all post-chemotherapy retroperitoneal lymph node dissection cases). The 3 indications for vena caval resection included tumor clearance (38%), vena caval scar occlusion (14%) and vena caval tumor thrombus (48%). En bloc vena caval resection to achieve tumor clearance was justified by subsequent nodal pathology (cancer in 63% of the specimens and teratoma in 31%). Vena caval resection in the presence of scar occlusion was de facto required by virtue of its incorporation in the specimen. Vena caval resection or thrombectomy is indicated for intraluminal tumor thrombus because thrombus pathology (cancer 35%, teratoma 45% and fibrosis 20%) reflected nodal pathology in 71% of the patients with cancer, 78% with teratoma and 100% with fibrosis. The complications of vena caval resection were generally transitory. The 71% survival rate justifies this intensive surgical approach because these patients had exhausted all chemotherapy options.

Adolescent↗
PubMed1989

Catecholamine excess: probable cause of postoperative tachycardia following retroperitoneal lymph node dissection (RPLND) for testicular carcinoma.

Review of the postoperative course of seven patients who underwent retroperitoneal lymph node dissection (RPLND) for staging of testicular carcinoma revealed an unexplained tachycardia that was persistent for several days. Postoperative catecholamine determinations from three subsequent patients subjected to RPLND revealed dramatic increases in epinephrine, norepinephrine, dopamine, and total catecholamines. Since cardiac acceleration is mediated almost exclusively by sympathetic stimulation, this finding may explain the postoperative tachycardia observed in these patients.

Adolescent↗
PubMed1976

Radical retroperitoneal lymph node dissection: how effective in removal of all retroperitoneal nodes?

Several large series have supported the success of retroperitoneal lymphadenectomy as a primary therapeutic modality in the management of non-seminomatous germ cell testicular neoplasms. In 1963 Tavel and associates reported on the inadequacy of this procedure in the complete extirpation of all the retroperitoneal lymph nodes. Our investigation was undertaken to test their conclusions, the sole difference in technique being that the infrarenal lumbar vessels were ligated and divided during the lymph node dissection. Results in 12 cadavers revealed that all retroperitoneal nodal tissue could be excised with the modified technique. These findings were further verified by the absence of any residual retroperitoneal lymph nodes in 3 patients who died of metastatic embryonal cell carcinoma. The extirpative efficacy of this procedure having been established, any major deleterious effects of lumbar ligation, primarily spinal cord ischemia, must be considered. Based on our experience and that of others it may be concluded that this complication represents a minimal risk that should not discourage use of this effective therapeutic procedure.

Aged↗
PubMed1991

[Studies on retroperitoneal lymph node dissection concerning postoperative ejaculatory function in patients with testicular cancer].

This study was done to explore the appropriate procedure of retroperitoneal lymph node dissection (RLND) to preserve ejaculatory function. The relation between postoperative ejaculatory function and area dissected at RLND was investigated in 47 patients with testicular cancer. The patients were divided into 5 groups according to the retroperitoneal area dissected. Group 1 (38 patients) underwent bilateral RLND, group 2 (3 patients) and 3 (2 patients) right unilateral RLND, and group 4 (2 patients) and 5 (2 patients) left unilateral RLND. The vertical limits of the dissected area were similar in all groups, namely renal pedicle and bifurcation of common iliac artery. The lateral limits were bilateral ureters in group 1, right border of aorta and right ureter in group 2, left border of aorta and left ureter in group 4, and vena cava and left ureter in group 5. Group 3 was similar to group 2, but the paraaortic region at the root of inferior mesenteric artery was also dissected. All patients in group 1 had dry ejaculation. Thirty patients in this group were examined for seminal emission and none of them could demonstrate seminal emission. Normal antegrade ejaculation was seen in group 2 and 4 patients, but retrograde ejaculation was recognized in group 3. Inability of seminal emission ws confirmed in group 5 patients. When consideration is given to the function of retroperitoneal sympathetic nerves, our results suggest that unilateral RLND without impairing superior hypogastric plexus should be adopted to preserve ejaculatory function.

Adolescent↗
PubMed1991

Retroperitoneal lymph node dissection in the treatment of patients with non-seminoma testicular tumours.

Twelve years of experience in performing retroperitoneal lymph node dissection (RPLND) in patients with testicular non-seminomas is presented. One hundred and fifty-two procedures were performed during the years 1977-1989. Seventy-four patients had RPLND prior to chemotherapy and 78 were operated on after the initial chemotherapy. The disparity between the initial staging and intra-operative findings was 35% in the first group and 16% in the second. The mortality rate in both groups was similar (20.3% and 20.5%, respectively). Forty-one of 78 patients operated on after the initial chemotherapy had vital or only partially damaged neoplastic tissue found in the specimen. The diagnostic and therapeutic significance of RPLND is discussed and the importance of the pathological findings in planning postoperative chemotherapy, and in prognosis is stressed.

Adolescent↗
PubMed1990

Is routine primary retroperitoneal lymph node dissection still justified in patients with low stage non-seminomatous testicular cancer?

We present 8 years' experience of primary retroperitoneal lymph node dissection (RLND) in 190 patients with low stage non-seminoma; 154 patients had clinical stage I (CSI) and 36 had clinical stage IIa (CSIIa) disease. Of the 154 patients with CSI tumours, 33 had increased serum AFP and/or HCG before RLND (CSIM+) and 121 had normal tumour markers (CSIM-). Retroperitoneal lymph node metastases (pathological stage II) (PSII) were found in 38 of 121 patients with CSIM-, in 19 of 33 patients with CSIIM+ and in 26 of 36 patients with CSIIa. In a multivariate analysis, the presence of small vessel infiltration (demonstrated in histological sections of the primary tumour) and a prolonged tumour marker half-life were predictive factors for PSII. These 2 factors enabled a group of non-seminoma patients with CSI disease to be identified who had a 15% risk of retroperitoneal tumour growth (low risk group) as compared with a high risk group where 60 to 70% of patients had retroperitoneal lymph node metastases. Relapses occurred in 7 of 107 patients with PSI and in 6 of 83 patients with PSII disease; in the latter group, 5 relapses developed before the start of routine adjuvant chemotherapy; 6% of patients developed major post-operative complications. In addition, "dry ejaculation" was the principal side effect following RLND (unilateral RLND: 20/132 patients; bilateral RLND: 50/54 patients). The comparative cost to the health service during the first year of follow-up was estimated for low risk non-seminoma patients with CSI subjected to RLND and for those in whom a surveillance policy was adopted. The latter approach was preferable. It was concluded that a surveillance policy should be followed in low risk non-seminoma CSI patients provided that frequent follow-up is possible. A more active policy is recommended in high risk patients (e.g. adjuvant chemotherapy without RLND). Nerve-sparing RLND may be considered in patients with CSIIa disease and negative tumour markers.

Adolescent↗
PubMed1991

[AIH in male infertility due to retrograde ejaculation after retroperitoneal lymph node dissection].

A patient with testicular cancer (non-seminoma, stage IIB) who had undergone resection for primary disease and retroperitoneal lymph node dissection as well as chemotherapy and radiotherapy 6 years before developed iatrogenic retrograde ejaculation. The infertility was treated by oral medications, including herbal medicine and injections of a hormone preparation as well as artificial insemination of husband (AIH). After 24 sessions of AIH for 4 years, his spouse gave birth to a healthy baby girl. We believe that for patients with iatrogenic retrograde ejaculation AIH is an effective method of increasing fertility to be employed more often.

Adult↗
PubMed1985

Post-treatment fertility in patients with testicular cancer. I. Influence of retroperitoneal lymph node dissection on ejaculatory potency.

"Dry ejaculation" occurred in none of 15 patients with testicular cancer treated by right-sided retroperitoneal lymph node dissection (RLND). After left-sided and bilateral RLND, "dry ejaculation" was observed in 7/21 and 51/61 men respectively. Twelve of 21 patients with "dry ejaculation" or small volumes of seminal fluid had true retrograde ejaculation. In 7 of 10 men the ejaculatory volume increased significantly after treatment with imipramine chloride. Four men impregnated their wives during treatment with the drug. Without impairing the results of therapy it is possible to spare fibres from the sympathetic chains and pre-sacral plexus during RLND due to testicular cancer, thus preserving fertility in at least 40% of patients.

Adolescent↗