563 OUTCOMES IN PATIENTS UNDERGOING POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR BULKY RETROPERITONEAL MASSES

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease I1 Apr 2010563 OUTCOMES IN PATIENTS UNDERGOING POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR BULKY RETROPERITONEAL MASSES Eric Reid, Craig Nichols, and Siamak Daneshmand Eric ReidEric Reid More articles by this author , Craig NicholsCraig Nichols More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.809AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Up to 50% of patients who undergo induction chemotherapy for metastatic germ cell cancer have significant residual retroperitoneal disease requiring resection for complete cure. The goal of this study was to evaluate clinical outcomes for patients undergoing post-chemo retroperitoneal lymph node dissection (PC-RPLND) for bulky retroperitoneal masses. METHODS We performed a retrospective analysis of all patients at our institution that underwent a PC-RPLND from October 2004 to October 2009. We reviewed their hospital course, pathology, preoperative imaging, and follow up data. Patients were separated into three groups based on the size of the residual retroperitoneal mass: Group 1, less than 5 cm in size, group 2, 5-10 cm in size, and group 3, greater than 10 cm in size. Bulky retroperitoneal masses were defined as those greater than 5 cm in size. Clinical outcomes were also analyzed for three separate time periods: Perioperative, early post-operative (<30 days) and late post-operative (>30 days). RESULTS We identified 58 patients who met study criteria. A total of 60 operations were performed on these patients. Twenty-five patients had residual masses less than 5 cm in size, 24 patients had masses 5-10 cm in size, and 9 patients had a mass greater than 10 cm. Pathology on group 1 patients revealed 16% with residual cancer, 36% with teratoma, and 48% with fibrosis. These percentages changed for group 2 with 21% residual disease, 43% teratoma, and 36% fibrosis. One patient in group 3 (11%) had fibrosis while the 8 other patients had residual teratoma. Median blood loss was higher in groups 2 and 3 (1325 ml and 1050 ml versus 500 ml in group 1). The number of patients undergoing adjuvant procedures was also higher in groups 2 and 3 compared with group 1 (54% and 40% versus 24%). The percentages of early complications were 16%, 33%, and 40% in groups 1,2, and 3 respectively. Late complications were also slightly higher in groups 2(17%) and 3 (10%) than in group 1 (8%). No significant differences in the percentage of patients with disease recurrence were noted among groups 1,2, and 3(12%, 21% and 11%, respectively). CONCLUSIONS Patients with bulky masses have slightly higher perioperative morbidity but no significant change in rate of disease recurrence. Masses greater than 10 cm are likely to be teratomas. Resection of bulky retroperitoneal masses warrants addition preoperative planning, but can be curative in the majority of cases. Portland, OR© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e221 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Reid More articles by this author Craig Nichols More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...