A 7-year audit in a single centre of the results of the modified template retroperitoneal lymph node dissection for testicular teratoma.

Abstract

OBJECTIVE:

To audit the results of retroperitoneal lymph node dissection (RPLND) after chemotherapy for testicular nonseminomatous germ cell tumour (NSGCT) in a single centre over a 7-year period, using a modified template technique via a midline transabdominal approach.

PATIENTS AND METHODS:

Outcome data were collected prospectively on all patients undergoing RPLND for a residual retroperitoneal mass after chemotherapy for NSGCT between October 1990 and March 1998; 28 patients underwent 32 RPLNDs over this period.

RESULTS:

The clinical stage at presentation was stage I in three patients (12%), stage II in 15 (54%), stage III in one (4%) and stage IV in nine (32%). The histological classification included malignant teratoma differentiated in one patient, malignant teratoma intermediate in 12 (43%) and malignant teratoma undifferentiated in 12. Tumour markers were positive immediately before surgery in four patients. A midline transabdominal approach was used in 31 of the procedures. The size of the retroperitoneal tumour mass was <3 cm in four patients (13%), 4-8 cm in 16 (50%) and >9 cm in 12 (38%). Histology of the mass showed residual differentiated teratoma in 17 (53%), undifferentiated teratoma in six (19%), necrosis only in six (19%), adenocarcinoma in one and angiosarcomatous differentiation in two. There was no perioperative mortality. Eight patients had permanent loss of ejaculation (29%) and two had erectile dysfunction (7%). Five patients (20%) subsequently developed recurrent disease; three (12%) underwent reoperation for disease relapse (one requiring two further procedures), whilst two (8%) died from recurrent disease.

CONCLUSION:

An abdominal approach via a midline incision provides satisfactory access with minimal morbidity in most patients. Results comparable with larger series can be achieved in regional centres.

• Authors: C R Bell, G N Sibley
• Journal: BJU international (BJU Int) Vol. 84 Issue 6 Pg. 667-70 (Oct 1999) ISSN: 1464-4096 [Print] England
• PMID: 10510113 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Follow-Up Studies
• Humans
• Lymph Node Excision
• Male
• Medical Audit
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Prospective Studies
• Teratoma (mortality, surgery)
• Testicular Neoplasms (mortality, surgery)
• Treatment Outcome