Wood D P, Herr H W, Heller G, Vlamis V, Sogani P C, Motzer R J, Fair W R, Bosl G J
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
J Urol. 1992 Dec;148(6):1812-5; discussion 1815-6. doi: 10.1016/s0022-5347(17)37036-2.
For patients with advanced nonseminomatous germ cell tumors a retroperitoneal lymph node dissection is routinely performed following chemotherapy if the serum tumor markers have returned to normal. Bilateral retroperitoneal lymph node dissection has been recommended because metastatic deposits may be widespread. The aim of this study was to describe the distribution of retroperitoneal metastases following chemotherapy in patients with nonseminomatous germ cell tumor and determine if the extent of the retroperitoneal lymph node dissection can be modified. We studied 113 patients who had initially bulky retroperitoneal disease and underwent retroperitoneal lymph node dissection following chemotherapy. For the purposes of this study teratoma and malignant germ cell tumor are referred to as tumor. The most common location of tumor was the para-aortic area (91%) in patients with a left primary tumor and the interaortocaval area (78%) in those with a right tumor. Tumor was located outside the boundaries of a modified retroperitoneal lymph node dissection in 14 of the 60 patients with residual disease but the tumor was present within a palpable mass in 6 of these 14 patients. If the residual mass was removed and a modified retroperitoneal lymph node dissection was performed only 9 of the 113 patients (8%) would have tumor left in the retroperitoneum. For a select group of patients with advanced nonseminomatous germ cell tumor treated with chemotherapy, resection of the residual mass combined with modified retroperitoneal lymph node dissection is appropriate.
对于晚期非精原细胞性生殖细胞肿瘤患者，如果血清肿瘤标志物恢复正常，通常在化疗后进行腹膜后淋巴结清扫术。由于转移灶可能广泛存在，因此建议进行双侧腹膜后淋巴结清扫术。本研究的目的是描述非精原细胞性生殖细胞肿瘤患者化疗后腹膜后转移灶的分布情况，并确定腹膜后淋巴结清扫的范围是否可以调整。我们研究了113例最初腹膜后疾病广泛且化疗后接受腹膜后淋巴结清扫术的患者。在本研究中，畸胎瘤和恶性生殖细胞肿瘤统称为肿瘤。左侧原发性肿瘤患者中，肿瘤最常见的位置是腹主动脉旁区域（91%），右侧肿瘤患者中则是主动脉腔静脉间区域（78%）。在60例有残留病灶的患者中，有14例的肿瘤位于改良腹膜后淋巴结清扫范围之外，但在这14例患者中有6例的肿瘤存在于可触及的肿块内。如果切除残留肿块并仅进行改良腹膜后淋巴结清扫术，那么113例患者中只有9例（8%）会在腹膜后残留肿瘤。对于一组接受化疗的晚期非精原细胞性生殖细胞肿瘤患者，切除残留肿块并联合改良腹膜后淋巴结清扫术是合适的。
