Long-term results after inferior vena caval resection during retroperitoneal lymphadenectomy for metastatic germ cell cancer
Long-term results after inferior vena caval resection during retroperitoneal lymphadenectomy for metastatic germ cell cancer
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DOI：
10.1016/s0741-5214(98)70055-2
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发表时间：
1998-11-01
影响因子：
4.3
通讯作者：
Donohue, JP
中科院分区：
文献类型：
--
作者：
Beck, SDW;Lalka, SG;Donohue, JP
目的：分析转移性非精原细胞睾丸生殖细胞肿瘤(NSGCT)腹膜后淋巴清扫术中下腔静脉(IVC)切除的远期后遗症。B2、B3或C)。在后者中，65例(6.8%)患者在肿瘤切除期间需要肾下下腔静脉切除以治愈。我们的方案不包括这种情况下的下腔静脉重建。下腔静脉切除的适应证包括肿瘤包绕或侵犯、化疗后促纤维组织增生性压迫、血栓伴肿瘤或凝块，不能进行腔静脉和血栓切除。结果：65例患者中有24例(术后随访11个月至16年，中位数89个月)存活，并能够通过书面和/或电话调查进行检查或访谈：评估其NC切除的长期发病率。根据1994年美国静脉论坛国际共识委员会报告标准，这24例患者的临床分类为COA(4例)、C-3S(4例)、C-4A(2例)、C-4S(13例)和C-6A(1例)。结论：接受调查的患者中只有1例(4.2%)有慢性静脉后遗症，符合后续选择性NC重建的可接受标准。尽管最近的报道显示NC重建具有较好的通畅率和较低的发病率，但对于转移性NSGCT的NC切除，在广泛的腹膜后淋巴结清扫中增加这种复杂、耗时的程序通常是没有必要的。
Purpose: The long-term sequelae of inferior vena caval (IVC) resection during retroperitoneal lymph node dissection for metastatic nonseminomatous germ cell testis tumor (NSGCT) were assessed.Methods: Between December 1973 and September 1996, 2126 of our patients underwent RPLND for retroperitoneal nodal metastases from NSGCT; 955 had bulky disease (stages. B2, B3, or C) after cytoreduction chemotherapy. Of this latter group, 65 patients (6.8%) required infrarenal IVC resection during tumor excision for cure. Our protocol does not include IVC reconstruction in such cases. Indications for IVC resection included tumor encasement or encroachment, postchemotherapy desmoplastic compression, or thrombus with tumor or clot in which cavotomy and thrombectomy cannot be performed.Results: Twenty-four of the 65 patients (postoperative follow-up period range, 11 months to 16 years; median, 89 months) were alive and able to be examined or interviewed by written and/or phone survey:to assess the long-term morbidity of their NC resection. Based on the 1994 American Venous forum International Consensus Committee reporting standards, the clinical classifications of these 24 patients were COA (4), C-3S (4), C-4A (2), C-4S (13), and C-6A (1). Long-term disability was mild or absent in 75% of these patients.Conclusion: Only 1 (4.2%) of the patients surveyed had chronic venous sequelae that would fulfill the accepted criteria for subsequent elective NC reconstruction. Despite recent reports of NC reconstruction demonstrating relatively good patency rates and low morbidity, the addition of such a complex, time-consuming procedure to extensive retroperitoneal lymph node dissection for metastatic NSGCT involving NC resection is generally not necessary.