Post-chemotherapy retroperitoneal lymph node dissection for non-seminomatous germ cell tumors: A single-surgeon, Canadian experience

Keywords: testicular cancer, testicular neoplasm, retroperitoneal lymph node dissection, complication, urology, oncology, Germ cell tumor, retroperitoneum

Abstract

Introduction: Post-chemotherapy retroperitoneal lymph node dissection (PCRPLND) has a well-established role in the management of residual retroperitoneal masses >1 cm in patients with advanced non-seminomatous germ cell tumor (NSGCT). Herein, we report our single-surgeon surgical experience in a Canadian tertiary hospital.

Methods: We identified 57 patients with NSGCT who received primary chemotherapy and PCRPLND from 2010–2016. Surgical complication rate was graded with Clavien-Dindo classification. Chi-squared testing was used in testing for differences in proportion of PCRPLND tumor histology vs. the historical cohorts. Chi-squared testing was also used to analyze the association between primary orchiectomy tumor histology and post-chemotherapy residual mass (PCRM) tumor histology.

Results: The overall complication rate was 23% (n=13), of which four were Clavien-Dindo grade IIIb and one was grade IVa. Fourteen percent of patients required additional procedure for resection of adjacent organs intraoperatively. There was a statistically significant difference in the distribution of PCRPLND tumor histologies (Chi-squared p=0.0187), with a lower rate of viable tumor (7%) and higher rate of teratoma (63%) compared to historical cohorts. The absence of teratoma in the primary orchiectomy specimen was associated with the findings of fibrotic/necrotic tissue in the PCRM (Chi-squared p=0.0005).

Conclusions: Our series demonstrated that the rate of viable tumor in PCRM appears lower than published historical series, and this possibly reflects the improvement in chemotherapy delivery in a contemporary series. The high rate of teratoma in the PCRM calls for ongoing need for PCRPLND. Grade III and IV surgical complications are considered rare in our series.

Author Biographies

Joshua King

Biological Sciences, University of Lethbridge

Jun Kawakami

Division of Urology, Department of Surgery, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada

Daniel Heng

Division of Medical Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada

Chun Loo Gan

Division of Medical Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada

Published
2020-03-30
How to Cite
King, J., Kawakami, J., Heng, D., & Gan, C. L. (2020). Post-chemotherapy retroperitoneal lymph node dissection for non-seminomatous germ cell tumors: A single-surgeon, Canadian experience. Canadian Urological Association Journal, 14(9), E407-11. https://doi.org/10.5489/cuaj.6219
Section
Original Research