MP50-09 CONTEMPORARY OUTCOMES OF PRIMARY EXTRAPERITONEAL RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGE II GERM CELL TUMORS

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP50-09 CONTEMPORARY OUTCOMES OF PRIMARY EXTRAPERITONEAL RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGE II GERM CELL TUMORS Muhannad Alsyouf, Arman Ashrafi, Sanam Ladi Seyedian, Erika L. Wood, Antoin Douglawi, Hamed Ahmadi, Madeleine Burg, Alireza Ghoreifi, Sumeet Bhanvadia, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Arman AshrafiArman Ashrafi More articles by this author , Sanam Ladi SeyedianSanam Ladi Seyedian More articles by this author , Erika L. WoodErika L. Wood More articles by this author , Antoin DouglawiAntoin Douglawi More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with germ cell tumors (GCT) and clinically low volume retroperitoneal adenopathy have multiple treatment options offering excellent oncologic outcomes. Primary retroperitoneal lymph node dissection (RPLND) is a treatment option that avoids the long term side effects of systemic therapies, however, can be associated with short term morbidity. The objective of this study was to evaluate the perioperative and oncologic outcomes of GCT patients who underwent a primary RPLND via an open extraperitoneal approach (EP RPLND) for the management of clinical stage II (CSII) GCT. METHODS: All GCT patients with marker negative, CSII who underwent a primary EP-RPLND between 2010-2021 were reviewed. The study population included patients with clinical stage (CS)I with retroperitoneal relapse & de-novo CSII patients. Perioperative, ejaculatory function, & oncologic outcomes were evaluated including recurrence rates and patterns. RESULTS: Overall, 45/170 EP-RPLND were performed in the primary setting (20 seminoma, 45 NSGCT). Median radiologic disease size was 1.7cm(IQR 1.3-2.3). Median number of lymph nodes resected was 35(IQR 23–46.5). Three patients (6.7%) experienced a 90-day complication. There were no cases of postoperative ileus, and median hospital stay was 2(IQR 1-3) days. In patients who underwent nerve sparing, 40/44 (91%) maintained antegrade ejaculatory function. pN+ rate was 90% in seminoma and 68% in NSGCT. In seminoma patients, 20 underwent a primary EP-RPLND. At a follow-up of 37.4 months, only 2 patients (10%) with stage IIA developed recurrence: 1 in-field (at 33.3 months follow-up) and 1 outside-field recurrence (at 42.7 months). Both were successfully managed with subsequent surgical resection, with an overall survival (OS) and systemic treatment free survival (STFS) of 100%. In 25 NSGCT patients with a median follow-up of 20.9 months, there were 6 recurrences (24%, 3 stage IIA, 3 stage IIB) at a median time of 3.1 months. All of these recurrences were successfully managed with chemotherapy (OS 100%, STFS 76%). CONCLUSIONS: In CSII GCT, a primary EP RPLND is safe, associated with short hospitalization, and offers excellent oncologic outcomes while minimizing patients morbidity. In this series, all seminoma patients and 76% of NSGCT patients avoided systemic therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e688 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhannad Alsyouf More articles by this author Arman Ashrafi More articles by this author Sanam Ladi Seyedian More articles by this author Erika L. Wood More articles by this author Antoin Douglawi More articles by this author Hamed Ahmadi More articles by this author Madeleine Burg More articles by this author Alireza Ghoreifi More articles by this author Sumeet Bhanvadia More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...