Post-chemotherapy retroperitoneal lymph node dissection in the management of metastatic testis cancer: the 16-year experience in an Irish setting
Post-chemotherapy retroperitoneal lymph node dissection in the management of metastatic testis cancer: the 16-year experience in an Irish setting
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DOI：
10.1007/s11845-015-1394-2
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发表时间：
2016-11-01
影响因子：
2.1
通讯作者：
Thornhill, J. A.
中科院分区：
文献类型：
--
作者：
Considine, S.;Heaney, R.;Thornhill, J. A.
化疗后腹膜后淋巴结清扫术（PC-RPLND）是晚期生殖细胞睾丸癌，特别是非睾丸癌的管理的重要工具。我们介绍了在爱尔兰一个三级转诊中心使用PC-RPLND的16年经验，并将我们的结果与全球主要专科中心进行比较。所有78例接受PC-纳入了1996年1月至2011年12月期间用于治疗转移性睾丸癌的RPLND。我们回顾了医疗记录，并从初级转诊中心、患者的全科医生和个体患者访谈中获得了最新的随访资料。初始病理学包括非腺瘤62.8%，腺瘤6.4%和合并19.2%。所有患者均接受术前化疗。使用的切除模板为双侧肺门下29.5%，单侧肺门下46.2%和肺门上20.5%。除一名患者外，所有患者均实现腹部完全缓解。38.5%的患者（n = 30）需要额外手术。Clavien Dindo 3级或4级并发症发生率为8.9%，包括5例需要早期再次手术的患者。RPLND标本的组织学显示成熟畸胎瘤（41%）和活动性癌（11.5%）。66例患者（85%）的随访数据可用。中位随访时间为101（11-207）个月。9例患者复发，中位复发时间为15（8-60）个月。总体5年生存率为95.2%（4例死亡）。在这个相对较小的系列中，由于人群较少和疾病发生率较低，与主要国际中心相比，我们已经证明PC-RPLND的围手术期病程、发病率和肿瘤学结局是可以接受的。
Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is an important tool in the management of advanced germ cell testis cancer, particularly non-seminoma.We present the 16-year experience with PC-RPLND in a single Irish tertiary referral centre, and compare our results to the major speciality centres worldwide.All 78 patients undergoing PC-RPLND for the treatment of metastatic testis cancer between January 1996 and December 2011 were included. Medical records were reviewed and up to date follow-up obtained from primary referral centres, patient's GPs and individual patient interview.The mean age at diagnosis was 28.5 +/- A 7 years. Initial pathology included non-seminoma 62.8 %, seminoma 6.4 % and combined 19.2 %. All patients underwent pre-operative chemotherapy. The resection template utilised was bilateral infra-hilar in 29.5 %, unilateral infra-hilar in 46.2 % and supra-hilar in 20.5 %. Complete abdominal remission was achieved in all but one patient. Additional procedures were required in 38.5 % of patients (n = 30). Clavien Dindo grade three or four complications were seen in 8.9 %, including five patients who required early reoperation. Histology of RPLND specimen showed mature teratoma (41 %) and active cancer (11.5 %). Follow-up data were available for 66 patients (85 %). Median follow-up was 101 (11-207) months. Nine patients relapsed with median time to relapse 15 (8-60) months. Overall 5-year survival rate was 95.2 % (four deaths).In this relatively small series due to small population and low disease incidence, we have shown acceptable peri-operative course, morbidity and oncological outcomes with PC-RPLND compared to major international centres.