888 - Laparoscopic lymph node resection of post-chemotherapy (post-CHT) residual retroperitoneal (RP) tumor masses in patients with non-seminomatous testi...

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Germ Cell Tumours
Surgical Oncology
Therapy
Radiation Oncology
Presenter Ivana Sullivan
Authors I.G. Sullivan1, G. Anguera1, C. Arqueros1, D. Condori1, J. Palou2, J.A. Peña2, H. Villavicencio2, P. Maroto3
  • 1Medical Oncology, Hospital de Sant Pau, 08041 - Barcelona/ES
  • 2Urology Department, Fundacio Puigvert, 08025 - Barcelona/ES
  • 3Dept. Of Medical Oncology, Hospital de Sant Pau, 08041 - Barcelona/ES

Abstract

Introduction

Resection of post-CHT residual masses, usually located in retroperitoneum, is an essential part of the management of NSTGCT. Presently, surgical procedure consists in an open unilateral retroperitoneal lymph node dissection (RPLND) of a modified template. Laparoscopic procedures have reduced morbidity compared to open surgery; in addition, limited lymphadenectomies or resection of essentially the residual mass may help to reduce morbidity, although it might have a higher incidence of local relapses.

Objective

To analyze relapse rate, morbidity and toxicity associated to laparoscopic RPLND in a series of patients (pts) with NSTGCT of a single tertiary referral center with surgeons who have extensive experience in post-CHT resection between January 2002 and January 2012.

Results

Retrospective analysis of 14 pts with a median follow-up of 40 months (m). Median age at diagnosis was 30 (18-43) years. Pathologic evaluation of the testis tumor revealed mixed NSTGCT with teratomatous elements in 11/14, and pure teratoma in 1. Embryonal carcinoma was presented in 12/14. Royal Marsden staging classification was: IIA: 2; IIB: 7; IIC: 2; IIIB: 1; IVB: 1, IVC: 1. All pts received a median of 4 cycles of BEP and had a complete serum marker response after induction CHT. RP masses showed a partial response in 8 and stable disease in 6 pts. Median size of the post-CHT retroperitoneum masses was 2,5 cm (1-10). Histologic examination showed fibrosis or necrosis in 4 (28%) and mature teratoma in 10 (64%) pts. Toxicity: Median days of hospitalization were 4 (2-9). 5 pts showed decrease of at least 2 points in hemoglobin, not requiring transfusion support. Chylous ascites was reported in 1 and an infected RP hematoma in another 1 pts. 2 pts developed ejaculatory dysfunction. Only 1 patient experienced an early relapse (3 m after RPLND) requiring salvage laparotomy. Pathology of the RP mass in this case reported a growing teratoma. All pts are alive and presently free of disease.

Conclusion

In our series, in a Hospital with long expertise in RP surgery, laparoscopic RPLND provided a low rate of complications and RP relapses, reducing morbidity comparing to historical series with open procedures.

Disclosure

All authors have declared no conflicts of interest.