Ehrlich Yaron, Yossepowitch Ofer, Kedar Daniel, Baniel Jack
Department of Urology, Rabin Medical Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BJU Int. 2006 Jun;97(6):1221-4. doi: 10.1111/j.1464-410X.2006.06167.x.
To assess the clinical and pathological findings of patients treated by bilateral retroperitoneal lymph node dissection (RPLND) after chemotherapy, to identify a subset for whom modified template nodal resection might be contemplated, as bilateral RPLND is the treatment of choice in patients with residual retroperitoneal disease after chemotherapy for nonseminomatous germ-cell tumour (GCT).
The medical records were reviewed of 50 consecutive patients who had RPLND after chemotherapy between 1996 and 2005. Bilateral template RPLND was performed uniformly. Extracted lymph nodes were surgically stratified into three distinct anatomical zones by two sagittal planes running in front of the aorta and the inferior vena cava. The pathological findings were correlated with the side of the primary lesion and the extent of metastatic disease before chemotherapy.
Pathological assessment of the resected lymph nodes revealed teratoma in 28 patients (56%), viable carcinoma in three (6%), and necrosis or fibrosis in 19 (38%). All clinical stage Is, IIA and IIB left-sided primary tumours followed a predictable pattern of spread constricted to a modified left-sided template. Patients with clinical stage IIC and III, or right-sided primary tumour, had a less predictable metastatic pattern, having crossover metastases to the contralateral template.
Bilateral RPLND should be considered as the reference standard in patients with metastatic GCT and residual retroperitoneal mass after completing chemotherapy. However, the present data suggest that a modified template dissection might be considered even after chemotherapy in patients with left-sided primary tumours and limited nodal involvement at presentation.
评估化疗后接受双侧腹膜后淋巴结清扫术（RPLND）患者的临床和病理结果，以确定可能考虑采用改良模板淋巴结切除术的患者亚组，因为双侧RPLND是化疗后残留腹膜后疾病的非精原细胞性生殖细胞肿瘤（GCT）患者的首选治疗方法。
回顾了1996年至2005年间50例化疗后接受RPLND的连续患者的病历。均进行双侧模板RPLND。通过在主动脉和下腔静脉前方运行的两个矢状平面将提取的淋巴结手术分层为三个不同的解剖区域。将病理结果与原发病变的部位和化疗前转移疾病的范围相关联。
对切除淋巴结的病理评估显示，28例患者（56%）有畸胎瘤，3例（6%）有存活癌，19例（38%）有坏死或纤维化。所有临床分期为I期、IIA期和IIB期的左侧原发性肿瘤均遵循可预测的转移模式，局限于改良的左侧模板。临床分期为IIC期和III期的患者或右侧原发性肿瘤患者的转移模式较难预测，存在对侧模板的交叉转移。
对于转移性GCT且化疗后残留腹膜后肿块的患者，应将双侧RPLND视为参考标准。然而，目前的数据表明，对于左侧原发性肿瘤且就诊时淋巴结受累有限的患者，即使在化疗后也可考虑采用改良模板清扫术。
