831 PATHOLOGICAL ANALYSIS OF RESECTED GONADAL VEIN AND TESTICLE POST-CEMOTHERAPY AT TIME OF RETROPERITONEAL LYMPH NODE DISSECTION FOR TREATMENT OF METASTATIC GERM CELL TESTICULAR CANCER

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011831 PATHOLOGICAL ANALYSIS OF RESECTED GONADAL VEIN AND TESTICLE POST-CEMOTHERAPY AT TIME OF RETROPERITONEAL LYMPH NODE DISSECTION FOR TREATMENT OF METASTATIC GERM CELL TESTICULAR CANCER Charles Metcalfe, Lydia Liao, Martin Gleave, Larry Goldenberg, and Allan So Charles MetcalfeCharles Metcalfe Vancouver, Canada More articles by this author , Lydia LiaoLydia Liao Vancouver, Canada More articles by this author , Martin GleaveMartin Gleave Vancouver, Canada More articles by this author , Larry GoldenbergLarry Goldenberg Vancouver, Canada More articles by this author , and Allan SoAllan So Vancouver, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.651AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of performing a retroperitoneal lymph node dissection (RPLND) for node positive disease post-chemotherapy for metastatic germ cell cancer is well established. The complete dissection of the gonadal vein to the level of the deep inguinal ring is viewed as a key surgical maneuver in rendering the patient disease free. Moreover, in patients in whom chemotherapy was initiated prior to orchiectomy, radical orchiectomy of the initiating testicle is performed at the time of RPLND to complete curative management. We evaluate the pathological findings of full gonadal vein dissection and the orchiectomy specimens in patients treated with RPLND post-cisplatin based chemotherapy for metastatic non-seminomatous germ cell cancer. METHODS Pathologic databases from a single tertiary institution that performs the majority of post chemo-RPLNDs (PC-RPLNDs) in British Columbia were reviewed from 1990–2010. Two different searches were performed retrospectively. The first being all PC-RPLND cases with pathologic analysis of the gonadal vein, and the second being all PC-RPLND cases combined with orchiectomy of the cancerous testicle. The data was analyzed and the presence of disease from gonadal vein dissection and from the orchiectomy specimens was examined. RESULTS Between 1990–2010, 117 PC-RPLND's were performed with pathological analysis of the lymph node tissue and the ipsilateral gonadal vein. 106 (90%) of gonadal veins and the adjacent tissue was negative for any disease. 7 (6%) had evidence of teratoma, 2 (2%) had embryonal tissue, 1 (1%) and 1 (1%) were positive for choriocarcinoma and mixed germ cell tissue respectively. Of the 11 positive samples, 5 had invasive disease within the gonadal vein and 6 had node positive disease along the gonadal vein. The second search revealed twenty-three cases in which the orchiectomy was performed post-chemotherapy at time of RPLND. 16 (70%) testicles had no evidence of disease and the remaining 7 (30%) revealed teratoma. The RPLND resulted in 14 (61%) of node dissections negative for disease, 7 (30%) and 2 (9%) detected teratoma and mixed germ cell disease respectively. CONCLUSIONS With the goal of a post-chemotherapy RPLND being complete cure, the added morbidity of the gonadal vein dissection and orchiectomy in patients with remaining testicle is justified. These steps are essential to maximize treatment. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e334-e335 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Metcalfe Vancouver, Canada More articles by this author Lydia Liao Vancouver, Canada More articles by this author Martin Gleave Vancouver, Canada More articles by this author Larry Goldenberg Vancouver, Canada More articles by this author Allan So Vancouver, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...