696P - Post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for metastatic pure seminoma

Background

Surgical resection of post-chemotherapy residual masses for metastatic seminoma is discussed controversially. We report the outcome of patients with pure seminoma who underwent PC-RPLND.

Methods

In this retrospective multi-institutional study, pure seminoma patients who underwent PC-RPLND for marker negative, FDG-PET/CT positive residual masses > 3cm or marker negative retroperitoneal relapse following first line chemotherapy between 2000 and 2023 were included. Patients with residual masses and negative FDG-PET/CT, inadequate systemic chemotherapy, insufficient clinical data, positive markers, or with residual or relapsing masses following salvage chemotherapy were excluded. Perioperative and long-term outcomes were reviewed.

Results

129 patients who received first-line cisplatin-based chemotherapy were included. Clinical features of the patients are presented in the table. 92.2% of PC-RPLNDs were performed via an open transperitoneal approach. Adjunctive surgery was performed in 46 (36%) pts. Median (IQR) blood loss and length of hospital stay were 550 (300 – 5800) mL and 4 (2 – 18) days, resp. Clavien - Dindo complications ≥ 3a developed in 12 (9.3%) pts. Pathology revealed necrosis/fibrosis in 87 (67%) and seminoma in 42 (33%). Marker negative progression (p

Conclusions

One third of patients with progressive or > 3cm FDG-PET-CT positive residual retroperitoneal masses following first-line chemotherapy for metastatic seminoma may have viable tumor. In selected cases, PC-RPLND may be a valuable option if performed in high-volume centers with expertise in testicular cancer management.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Axel Heidenreich.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.