Okamura K, Yuba H, Nishimura T, Mizutani K, Takashi M, Gotoh M, Ono Y, Ohshima S
Department of Urology, Nagoya University School of Medicine.
Hinyokika Kiyo. 1999 Feb;45(2):95-101.
We performed retroperitoneal lymph node dissection (RPLND) on 14 patients (IIA: 1, IIB: 4, IIIA: 3, IIIB2: 2, IIIC: 4) with testicular and one with retroperitoneal germ cell tumor at the Nagoya University Hospital between 1986 and 1997. According to the international germ cell consensus classification, 4 patients were classified as "good-prognosis", three as "intermediate-prognosis" and eight as "poor-prognosis". RPLND was performed on 12 patients with the tumor marker levels normalized preoperatively and on three without the marker normalization. The mean surgical time was 510 (195-1, 125) minutes and the mean bleeding volume was 3,806 (100-12,598) g. The surgical time and bleeding volume were correlated with the size of the tumor in the body axis. Intraoperative complications occurred in 5 (33%) out of 15 patients: injury of renal artery (2), renal vein (1), ureter (1) and common iliac artery (2). Postoperative complications occurred in 2 patients: ileus (2) and lower extremity edema resulting from resection of the inferior vena cava (1) and would dehiscence (1). Of the 8 patients whose completely resected retroperitoneal tumors were necrosis/fibrosis or teratoma (psCR), 6 achieved survival with no evidence of disease (NED). Among 4 patients, whose tumor was not completely resected but pathologically diagnosed as necrosis/fibrosis or teratoma (pCR), NED without recurrence was achieved in 2 and also in one with resection of relapsed teratoma 2.5 years after RPLND. All three patients with cancer tissues pathologically retained in the resected tumors (sCR or psIR), consequently died of the disease. In six patients with relapse, the initial sign was elevation of the tumor marker levels, which was noted more than 30 days postoperatively in 2 patients with psCR and 7 to 15 days in 4 patients without psCR. We believe that RPLND is needed to examine the pathology and to predict the prognosis of the poor-risk patients with NSGCT. Careful dissection of vessels is needed to reduce vascular complications.
1986年至1997年间，我们在名古屋大学医院对14例睾丸生殖细胞肿瘤患者（IIA期：1例，IIB期：4例，IIIA期：3例，IIIB2期：2例，IIIC期：4例）以及1例腹膜后生殖细胞肿瘤患者进行了腹膜后淋巴结清扫术（RPLND）。根据国际生殖细胞共识分类，4例患者被归类为“预后良好”，3例为“预后中等”，8例为“预后不良”。12例患者在术前肿瘤标志物水平恢复正常后接受了RPLND，3例患者未实现标志物正常化也接受了该手术。平均手术时间为510（195 - 1,125）分钟，平均出血量为3,806（100 - 12,598）克。手术时间和出血量与肿瘤体轴大小相关。15例患者中有5例（33%）发生术中并发症：肾动脉损伤（2例）、肾静脉损伤（1例）、输尿管损伤（1例）和髂总动脉损伤（2例）。术后并发症发生在2例患者中：肠梗阻（2例）、因下腔静脉切除导致的下肢水肿（1例）和伤口裂开（1例）。在8例腹膜后肿瘤完全切除且为坏死/纤维化或畸胎瘤（病理完全缓解，psCR）的患者中，6例实现了无疾病证据（NED）的生存。在4例肿瘤未完全切除但病理诊断为坏死/纤维化或畸胎瘤（病理缓解，pCR）的患者中，2例实现了无复发的NED，1例在RPLND后2.5年复发畸胎瘤切除后也实现了NED。所有3例切除肿瘤中病理上仍保留癌组织（病理完全缓解或病理部分缓解，sCR或psIR）的患者最终均死于该疾病。在6例复发患者中，最初的迹象是肿瘤标志物水平升高，2例psCR患者在术后30天以上出现，4例非psCR患者在术后7至15天出现。我们认为，对于预后不良的非精原细胞瘤性生殖细胞肿瘤（NSGCT）患者，需要进行RPLND以检查病理并预测预后。需要仔细解剖血管以减少血管并发症。
