Complications of primary nerve-sparing retroperitoneal lymphadenectomy in clinical stage I nonseminatous testis cancer

370

369 PRIMARY COMPLICATIONS OF RETROPERITONEAL LYMPHADENECTOMY NONSEMINATOUS TESTIS CANCER Heidenreich Axel. Albers Peter, Kiihrmann Pottek Tobis, WeiBbach Lothar German

Testicular

Cancer

Study Group,

NERVE-SPARING IN CLINICAL STAGE I

OUTCOME ANALYSIS RHABDOMYOSARCOMA Matveev

Boris,

Urology,

Cancer

Guraryi

OF

Ludmila,

72

CASES

Volkova

OF

Maria.

PARATESTICULAR

Matveev

Vsevolod

Kai Uwe, Krege Susanne,

Philipps

University,

Marburg,

Germany

INTRODUCTION

& OBJECTIVES: Nerve sparing retroperitoneal lymphadenectomy (nsRPLND) has been the standard diagnostic and therapeutic approach in clinical stage I nonseminomas (NSGCT). However. the application of prognostic risk factors and the introduction of laparoscopy have questioned the clinical utility of nsRPLND recently. The purpose of our study was to assess therapeutic efficacy and associated complications of naRPLND in CS I NSGCT to evaluate its role in the modern management of low stage testis cancer.

MATERIALS

& METHODS: Between January I995 and September 2000, 2 15 patients with CS I NSGCT have undergone nsRPLND in atandardised fields of dissection. For retrospective analysis patient charts were reviewed: a minor complication did not prolong the hospital stay, a major complication prolonged hospitalisation for at least 2 days. Early complications developed within the first 30 days following RPLND, late complications occurred from postoperative day 31,

RESULTS:

nsRPLND was performed unilaterally in 189 patients (88%) and bilaterally in 26 patients (12%); median surgical time was 214 (90-395) minutes, mean hospital stay was 8 (4-19) days. Mean blood loss was less than SO ml. A mean of I X.5 (9-57) lymph nodes were dissected with metastases being detected in 58 patients (27%). On average 2.9 (I-14) lymph nodes with a mean diameter of 2.6 cm (0.3-6.0) exhibited metastases. 38 patients (65.5%) had 5 3 metastatic lymph nodes, I4 patients (24.1%) had 4-S positive nodes and 6 patients (10.3%) had >5 positive nodes. Minor complications occurred in 13.5% of the patients, major complications were observed in 3.5%. Antegrade ejaculation was preserved in 199121.5 patients (92.6%); recurrences developed in IO patients (10.7%). a retroperitoneal reccurence was only observed in I patient (0.5%).

CONCLUSION:

Primary diagnostic and therapeutic nsRPLND still has its role in the primary management ofclinicalstage I NSGCT; surgery is associated with low morbidity, follow-up of the patients becomes easy and cost effective due to concentration on the extraretroperitoneal locations. Primary nsRPLND will be curative in about 70% of CS I NSGCT with a maximum of 3 positive lymph nodes.

Research

Center,

Moscow,

Russia

INTRODUCTION & OBJECTIVES: Paratesticular rhabdomyosarcoma (PR) is an uncommon tumour arising from the mesenchymal tissues of spermatic cord, epididymis and testicular tunics. We retrospectively evaluated treatment modalities and outcome of patients with PR treated at our department. MATERIALS & METHODS: A retrospective analysis of 72 patients with PR treated from 1965 to 2000 at our institution was performed. Mean age of the patients was 17.8 years (range I .6 to 74). 46 patients (63.8%) had metastatic disease at presentation and 26 had local disease. 22 of 46 patients (47.8%) had only lymphatic involvement, 9 (19.5%) had distant parenchymal metastases, IS (32.7%) had both lymphatic and parenchymal secondaries. Inguinal orchectomy was performed in all cases. II of 26 patents with local disease received no further treatment. Retroperitoneal lymph node dissection (RLND) followed by chemotherapy and radiotherapy was performed in I4 of 46 patients with metastasis at presentation and in 7 patients with negative preoperative staging. Three of 7 patients had tumour foci in retroperitoneal lymph nodes that had not been detected before. One patient with solitary lung lesion underwent the pulmonary resection. 32 patients with advanced PR received only chemotherapy, 7 were treated with a combination of chemotherapy and radiotherapy, I with radiotherapy. The regimens of chemotherapy varied and included cisplatin, adriamycin, dactinomycin, carminomycin, vincristine and cyclophosphamide. RESULTS: The median follow-up period was 4 years. 36 of 72 patients remained free of disease. 8 are alive with metastases, 24 died of disease progression and 4 were lost to follow-up. 6 of I I patients who were treated with orchiectomy only had a disease progression a median of 6.7 months. All 7 patients after preventive RLND are alive free of disease a median of 72 months. The 3-year survival rate was 56.8% for the whole group and 100% for the patients without metastases. The survival of patients in whom RLND was performed was significantly better than in the conservative group (73.3% versus l7.S% respectively, pcO.05). CONCLUSION: Preventive RLND may improve survival of patients with negative preoperative screening. Patients with PR may benefit from combination of surgery, chemotherapy and radiotherapy.

371 FOLLOW-UP OF ORGAN-PRESERVING IN TESTICULAR TUMOURS Steiner Rogatsch

Hannes', Manschg Hermann*,

Hittmair

TUMOUR

ENUCLEATION

Christoph', Anton’,

‘Urology, University of Innsbruck, Innsbruck, Innsbruck, Austria

Hnltl Lorenr’ , Berger Andreas’. Bartsch Geog’ . Hobisch Alfred’

Innsbruck,Austria,

‘Pathology.

University of

INTRODUCTION & OBJECTIVES: In a retrospective study we evaluated indication, technique and follow-up of organ preserving tumour enucleation in 2X cases with uni- and bilateral testicular turnours. Considering quality of life issues our intention is to prevent young patients from lifelong androgen supplementation and loss of fertility.

372 POST-ORCHIECTOMY CHEMOTHERAPY (CHT) FOR LOW STAGE TESTICULAR SEMINOMA (TS): EXPERIENCE IN THE MANAGEMENT OF 116 CONSECUTIVE PATIENTS Areirovic

D.‘.Micic

S.‘. Adanja G.‘. Radosavljevic

R.‘, Bojanic N.’

‘Clinic of Urology. C.C.S., Belgrade, Yugoslavia. ‘Institute of Nuclear Medicine, C.C.S., Belgrade. Yugoslavia. ‘Institute of Pathology, C.C.S.. Belgrade, Yugoslavia

INTRODUCTION

& OBJECTIVES: Although radiation addressed to represents the standard treatment in clinical stage (CS) A and 81162. promising have been reported with adjuvant CHT. The aim of this study is to report our results with primary carboplatin (C) CHT in CS-A and platinum (P)-based CHT BliB2.

RPLN results initial in CS-

MATERIALS & METHODS: During the permd from July 1995 to March 2001, II 6 MATERIALS & METHODS: Organ preserving tumour enucleation was performed in 26 patients with a mean age of 32.2 (0.4-58.2) years. Three patients presented with bilateral synchronously occurring testicular turnours. One patient underwent enucleation on the same side twice. Mean tumour diameter was 15.8 mm. Histology revealed: pure seminoma (8). mixed germ cell tumour (2). mature teratoma (2). Leydig cell tumour (IO), Sertolitumour (2), fibrotic pseudo tumour (2). epidermoid cyst (I) and adenomatoid tumour (I). In 9 out of 12 patients with germ cell tumour associated testicular intraepithelial neoplasm (TIN) was diagnosed.

patients with TS were treated with primary CHT according to CS. 95 patients in CS-A received 2 cycles of CHT with C (400 mg/m’/cycle) in intervals of 3 weeks, whereas 5 patients with persistently post-orchiectomy elevated hCG received 3-4 cycles. In all patients CHT could be performed in and out patients basis during 2 hours. 16 patients in CS-B2 (LN metastasis 3 cm stable RM followed by selective consolidation with surgery.

RESULTS: 3 patients (3.0%) in CS-A recurred within mean free interval of I2 months RESULTS: Currently all patients are free of disease during a mean follow-up of 32.9 months. One patient underwent second enucleation because of local recurrence occurred ten months after first enucleation, he refused local irradiation of an associated TIN after first surgery. Two patients underwent inguinal orchidectomy after enucleation resection. one patient because of endocrine insufficiency of the remaining testis and one patient because of positive margins in final histology. Ail other patients had testosterone levels withm normal range postoperatively. CONCLUSION: Organ preserving tumour enucleation can be performed in bilateral testicular tumours, in tumours of a singular testis and non-malignant testicular turnours. To preserve endocrine function and fertility of the remaining parenchyma and to prevent local recurrence we suggest the following guidelines: organ confined tumour (~25 mm), enucleation resection under cold ischemia, possibility of frozen section, multiple biopsies of tumour bed and adjacent parenchyma. normal endocrine preoperative function and in case of associated TIN postoperative radiation.

(M) (range 12-28) following completion of CHT (1 RP+supraclavicular LN. lung; I RPLN: I only elevated hCG) and achieved CR with salvage CHT according to PEB (I) and PE (I ) regimen, respectively. All patients are alive and free of disease (AFD) after men follow-up (MFU) of 30.4 M (range 6-54). Besides mild gastrointestinal discomfort. CHT with C was well tolerated in all patients. Myelosupreasion was minimal with none of patients demonstrated leucopema and lhrombocytopenia gr III-LV. Side effects ,uch as renal. neuro. ototoxicity or alopecia were not observed. IS/l6 patients (93.75%) in CS82 entered in CR following CHT (2 patients with RM <3 cm). RPLND+salvage CHT for RM m PR was Indicated in I patient (histology: vital carcinoma). I patlent (6.52%) relapsed at I2 M in RPLN and achieved CR with salvage CHT. All patients are AFD after MFU of 25 M (range 6-71). Alopecia was nearly universal, and 6 patients (37.5%) experienced gr I-II nausea/vomiting. I patient complained of paresthesia and tinltus gr I. There were no gr II-IV neuro, renal. cardiac or any gr III-IV gastrointestinal toxycity.

CONCLUSION: Adjuvant

C CHT appear to be an altername approach in CS-A TS: application is easy. side effects arc mild and recurrence rate (RR) after short-term FU appear to be as low as after irradiation. Besides mild toxic effect\. management of patients in CS-B2 TS with PE regimen is treatment of choice having in view RR following irradiation in up to 24% patients.

European

Urology

Supplements

1 (2002) No. 1, pp. 95