832 PROGNOSTIC CLINICAL PARAMETERS TO PREDICT THE NECESSITY OF RECONSTRUCTIVE VASCULAR SURGERY FOR PATIENTS WHO UNDERGO POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (PC-RPLND) FOR ADVANCED NONSEMINATOUS GERM CELL TUMORS (NSGCT). RESULTS OF THE GERMAN TESTICULAR CANCER STUDY GROUP (GTCSG) AND THE ASSOCIATION OF UROLOGIC ONCOLOGY (AUO)

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011832 PROGNOSTIC CLINICAL PARAMETERS TO PREDICT THE NECESSITY OF RECONSTRUCTIVE VASCULAR SURGERY FOR PATIENTS WHO UNDERGO POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (PC-RPLND) FOR ADVANCED NONSEMINATOUS GERM CELL TUMORS (NSGCT). RESULTS OF THE GERMAN TESTICULAR CANCER STUDY GROUP (GTCSG) AND THE ASSOCIATION OF UROLOGIC ONCOLOGY (AUO) Axel Heidenreich, Klaus Peter Diekmann, Hans Schmelz, Christoph Winter, and David Pfister Axel HeidenreichAxel Heidenreich Aachen, Germany More articles by this author , Klaus Peter DiekmannKlaus Peter Diekmann Hamburg, Germany More articles by this author , Hans SchmelzHans Schmelz Koblenz, Germany More articles by this author , Christoph WinterChristoph Winter Düsseldorf, Germany More articles by this author , and David PfisterDavid Pfister Aachen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.652AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PC-RPLND remains an integral part of the multimodality treatment for advanced NSGCT. The need to resect and to replace the major retroperitoneal vessels must be known preoperatively to enable complete resection of the residual masses. METHODS PC-RPLND was performed in 411 patients with NSGCT and normalized (81%) or plateauing (19%) tumor markers following 3–4 cycles PEB/PEI. PC-RPLND was performed in 5 institutions with a variable surgical frequency of 14 to 158 PC-RPLNDs. Good, intermediate, and poor prognosis according to the IGCCCG criteria was identified in in 59.8%, 21.2%, and 19% respectively. RESULTS Resection of the inferior vena cava was performed in 28 (6.81%) patients, resection of the abdominal aorta was necessary in 13 (3.16%) patients. In 29/41 (70.7%) adjunctive surgical procedures such as nephrectomy, small bowel resection, ureteral resection had to be performed to ensure complete resection of the residual masses. Histologically vital carcinoma or mature teratoma was identified in 78.1% of the resected vascular specimens. Mean time of surgery was 295 (243–615) Min., mean blood loss was 690 (350 – 3400) ml. Good prognosis was identified in 15.4%, an intermediate and poor prognosis was present in 41%and 43.6%, respectively. Of all 411 patients involvement of the major retroperitoneal vessels was found in 3.2%, 18.4% and 21.8% with good, intermediate, and poor prognosis, respectively. The mean tumor diameter was 5.9 (1.0 – 32) cm for the entire cohort and 9.8 (4–32) cm for the cohort of patients with vascular surgery. Significant prognosticators to predict vascular involvement were identified by multivariate analysis: intermediate/poor prognosis, number of cycles of chemotherapy, tumor diameter > 14cm, circumferential encasement of > 50% of the vessel diameter. CONCLUSIONS Complete resection of the inferior vena cava or the abdominal aorta during PC-RPLND is necessary in about 10% of patients. The identified predictors enable already preoperatively a risk adapted interdisciplinary approach for complete resection of the residual masses in an experienced centre. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e335 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Axel Heidenreich Aachen, Germany More articles by this author Klaus Peter Diekmann Hamburg, Germany More articles by this author Hans Schmelz Koblenz, Germany More articles by this author Christoph Winter Düsseldorf, Germany More articles by this author David Pfister Aachen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...