Donohue John P
Department of Urology, Indiana University Medical Center, 535 North Barnhill Drive, Ste. 420, Indianapolis, IN 46202, USA.
Urol Oncol. 2003 Mar-Apr;21(2):129-32. doi: 10.1016/s1078-1439(02)00212-0.
The metastatic lymphatic drainage of testis cancer to the retroperitoneum was noted clinically about a century ago. Beginning with extraperitoneal approaches, RPLND was attempted. The first cure after RPLND of node positive disease was in 1905 by Cuneo in Paris. Transperitoneal approaches failed due to infection until post World War II experience at Walter Reed Army Hospital. Thoracoabdominal approaches became popular several decades later. But Improved exposure and vascular management strategies led to increased usage of the transabdominal approach once again. The advent of platinum based combination chemotherapy has had a major impact on both the timing of and the technical requirements of RPLND. Owing to our early involvement in this area, we have accumulated the largest database available on this disease. Our experience with over 2500 RPLNDs in the last 3 decades is divided between low stage (I and II) and high stage (III, postchemotherapy) disease. The former has been "down-regulated" to modified templates and prospective nerve sparing techniques to preserve ejaculation. The latter has been "up-regulated" to include a spectrum of surgical needs including hepatic, vascular, gut and mediastinal resections. Despite these extended requirements, outcomes are good (> 80% survival) postchemotherapy. The evolutionary change of RPLND reflects an optimal paradigm of surgical-medical oncologic interaction.
大约一个世纪前，临床上就已注意到睾丸癌会通过淋巴转移至腹膜后。从腹膜外途径开始，人们尝试进行腹膜后淋巴结清扫术（RPLND）。1905年，巴黎的库尼奥首次通过RPLND治愈了淋巴结阳性疾病。在第二次世界大战前，经腹途径因感染而失败，直到沃尔特·里德陆军医院在二战后的经验出现。几十年后，胸腹联合途径开始流行。但随着暴露和血管管理策略的改进，经腹途径的使用再次增加。铂类联合化疗的出现对RPLND的时机和技术要求都产生了重大影响。由于我们早期就涉足该领域，我们积累了关于这种疾病的最大可用数据库。在过去30年里，我们进行了超过2500例RPLND，经验涵盖低分期（I期和II期）和高分期（III期，化疗后）疾病。对于前者，已采用改良模板和前瞻性保留神经技术以保留射精功能，从而进行了“下调”。对于后者，则进行了“上调”，以满足一系列手术需求，包括肝脏、血管、肠道和纵隔切除术。尽管有这些更高的要求，但化疗后的预后良好（生存率>80%）。RPLND的演变反映了外科 - 肿瘤内科相互作用的最佳模式。
