Retroperitoneal lymph node dissection after chemotherapy

Christian Winter, Jay Raman, Joel Sheinfeld, Peter Albers

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

Retroperitoneal lymph node dissection after chemotherapy (PC-RPLND) plays a crucial role in managing patients with advanced germ cell tumours (GCTs). In the last few years improvements in radiographic staging, a better understanding of the role of serum tumour markers, and the introduction of cisplatin-based chemotherapy have all contributed to this surgical therapy. PC-RPLND is necessary when residual radiographic abnormalities are present after chemotherapy. The need for a PC-RPLND in the face of normal findings from computed tomography (CT) is controversial. CT criteria alone are not sufficiently reliable to distinguish viable tumour or teratoma from necrosis. No combination of variables can predict negative retroperitoneal pathology with sufficient accuracy after induction chemotherapy. Unresected teratoma or viable GCT are at least partly chemorefractory and, if untreated, will progress. So completeness of resection is an independent and consistent predictive variable of clinical outcome. In PC-RPLND surgical margins should not be compromised in an attempt to preserve ejaculation, although nerve-sparing dissections are possible in patients with marker normalization after chemotherapy and necrotic tissue in frozen-section histology. In these patients nerve-sparing techniques and the reduction of surgical field to the left- or right-sided template are applicable to preserve antegrade ejaculation and consecutive fertility. The size and location of residual masses coupled with the retroperitoneal desmoplastic reaction make PC-RPLND a technically demanding procedure that should be performed by experienced surgeons in dedicated referral centres.

Original languageEnglish (US)
Pages (from-to)1404-1412
Number of pages9
JournalBJU International
Volume104
Issue number9 B
DOIs
StatePublished - Nov 1 2009

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Lymph Node Excision
Drug Therapy
Ejaculation
Germ Cell and Embryonal Neoplasms
Teratoma
Tomography
Induction Chemotherapy
Frozen Sections
Tumor Biomarkers
Cisplatin
Fertility
Dissection
Histology
Necrosis
Referral and Consultation
Biomarkers
Pathology
Neoplasms
Therapeutics

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Winter, Christian ; Raman, Jay ; Sheinfeld, Joel ; Albers, Peter. / Retroperitoneal lymph node dissection after chemotherapy. In: BJU International. 2009 ; Vol. 104, No. 9 B. pp. 1404-1412.
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Retroperitoneal lymph node dissection after chemotherapy. / Winter, Christian; Raman, Jay; Sheinfeld, Joel; Albers, Peter.

In: BJU International, Vol. 104, No. 9 B, 01.11.2009, p. 1404-1412.

Research output: Contribution to journalReview article

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