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腹腔镜腹膜后淋巴结清扫术治疗临床I期非精原细胞性生殖细胞睾丸癌:长期随访结果

Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer: a long-term update.

作者信息

Bhayani Sam B, Ong Albert, Oh William K, Kantoff Philip W, Kavoussi Louis R

机构信息

James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

出版信息

Urology. 2003 Aug;62(2):324-7. doi: 10.1016/s0090-4295(03)00324-8.

Abstract

OBJECTIVES

To assess retrospectively the long-term cancer control in patients undergoing laparoscopic retroperitoneal lymph node dissection (RPLND) in the management of clinical Stage I nonseminomatous germ cell testicular tumors.

METHODS

A retrospective review of 29 patients undergoing laparoscopic RPLND was performed. All patients had clinical Stage I nonseminomatous germ cell testicular tumor, with vascular invasion and/or embryonal carcinoma in the orchiectomy specimen. A modified template dissection was performed. Patients with retroperitoneal metastases were offered two cycles of chemotherapy. A modified follow-up schedule was used in patients with pathologically negative nodes.

RESULTS

Lymph nodes were negative in 17 of 29 patients. Of these 17 patients, 15 had no recurrence and were free of disease with 5.8 years of follow-up. Two patients had recurrence, one in the chest, and one biochemically, and both were free of disease after chemotherapy. Twelve of 29 patients had lymph nodes with metastatic testicular cancer. Ten of these patients underwent adjuvant chemotherapy and were free of disease with 6.3 years of follow-up. One patient had a biochemical recurrence after positive RPLND and was salvaged with chemotherapy. One patient was observed after positive RPLND and was free of disease with 4.9 years of follow-up. The only long-term complication was retrograde ejaculation in 1 patient.

CONCLUSIONS

Laparoscopic RPLND is a safe, minimally invasive treatment option in patients with clinical Stage I nonseminomatous germ cell testicular tumor. The cancer control appears to be similar, with minimal morbidity compared with the open procedure.

摘要

目的

回顾性评估接受腹腔镜腹膜后淋巴结清扫术(RPLND)治疗临床I期非精原细胞性生殖细胞睾丸肿瘤患者的长期癌症控制情况。

方法

对29例行腹腔镜RPLND的患者进行回顾性分析。所有患者均为临床I期非精原细胞性生殖细胞睾丸肿瘤,睾丸切除标本中有血管侵犯和/或胚胎癌。采用改良模板清扫术。腹膜后转移患者接受两个周期的化疗。病理检查淋巴结阴性的患者采用改良随访方案。

结果

29例患者中17例淋巴结阴性。在这17例患者中,15例无复发,随访5.8年无疾病复发。2例患者复发,1例为胸部复发,1例为生化复发,化疗后均无疾病复发。29例患者中有12例淋巴结有转移性睾丸癌。其中10例患者接受辅助化疗,随访6.3年无疾病复发。1例患者RPLND阳性后出现生化复发,经化疗挽救。1例患者RPLND阳性后进行观察,随访4.9年无疾病复发。唯一的长期并发症是1例患者出现逆行射精。

结论

腹腔镜RPLND是临床I期非精原细胞性生殖细胞睾丸肿瘤患者安全、微创的治疗选择。与开放手术相比,癌症控制效果相似,发病率极低。

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