Study of the conformity of post-chemotherapy retroperitoneal lymph-node dissection (RPLND) to standard recommendations in patients with testicular (T) and primary retroperitoneal (PR) non-seminomatous germ-cell tumor (NSGCT): impact on outcome

Abstract

4584 Background: Post-chemotherapy RPLND is a major part of the initial treatment of T-PR NSGCT patients. The aim of the study was to determine whether its conformity to standard recommendations had an impact on pts outcome. Methods: We reviewed the clinical, surgical and histological charts of 533 T-PR NSGCT patients who were treated between 01/93 to 12/00 in our center. RPLND was performed in 153 patients after first-line chemotherapy by 69 different surgeons. One surgeon and 68 surgeons operated 49 patients and less than 8 patients respectively. We reviewed the distribution of involved lymph-node according to Donohue et al (J Urol 1982, 128:315). Recommendations used to define conformity to RPLND standards were: indication based on initial and residual lymph-node sizes and shrinkage (Toner, J Clin Oncol, 1990, 8: 1683), extension of dissection (Wood et al, J Urol 1992, 148: 1812 and Aprikian et al, Cancer 1994, 74: 1329) and completeness of exeresis. Criteria for outcome were relative risk (RR) of relapse and death. Results: RPLND was in conformity to standard recommendations in 71/153 (46%) patients (indication: 149/153, extension: 76/153, completeness of exeresis 129/153). Conformity was 100% for the surgeon who operated 49 patients and 26% for the others. Median follow-up was 3.08 years (0.42–11). There were 26 (17%) relapses (12 in the retroperitoneum) and 14 deaths. Patients who had not conformable RPLND had a 4.33 and 3.17 RR of retroperitoneal relapse and death respectively when compared to patients who had RLNPD performed according to standard recommendations. Conclusions: Conformity of RLNPD procedure to standard recommendation has an impact on outcome. Patients should be treated in reference centers. No significant financial relationships to disclose.