Liu Zhuo-Wei, Zhou Fang-Jian, Han Hui, Qin Zi-Ke, Yu Shao-Long, Li Yong-Hong, Ye Yun-Lin, Teng Xiao-Yu
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, PR China.
Ai Zheng. 2008 Dec;27(12):1302-6.
BACKGROUND & OBJECTIVE: Retroperitoneal lymph node dissection(RPLND) is one of the main modalities for nonseminomatous germ cell tumors (NSGCTs). RPLND has achieved relatively high efficacy for stage I/II NSGCTs. Currently, the postoperative complication rate of conventional RPLND is relatively high. This study was to summarize therapeutic efficacy of modified RPLND for stageI/II NSGCTs, thus to explore the reasonable therapy strategy for those diseases.
Clinical data of 31 patients with stage I/II NSGCTs underwent RPLND from Aug.2003 to Aug.2007 in Sun Yat-sen University Cancer Center, were retrospectively analyzed. All cases received modified RPLND after radical orchidectomy. Four cases received two to three cycles of BEP (bleomycin,etoposide and cisplatin) chemotherapy prior to RPLND. Thirteen cases received one to five cycles of adjuvant cisplatin-based chemotherapy after primary RPLND.
The mean operating time was 147 min (rang 120-200 min) and the mean blood loss was 116 ml (rang 50-300 mL) of modified RPLND. The mean number of dissected lymph nodes sent for pathological examination was 15 (rang 3-40). Retroperitoneal lymph node metastases were confirmed in 15 cases, two of which were fibrosis. According to the pathologic classification after operation, there were 16 cases at stage I, six cases at stage IIA, six cases at stage IIB, and three cases at stage IIC. There was no occurrence of perioperational and postoperational complications. The mean follow-up time was 33 months, ranged eight to 58 months. Twenty-nine patients achieved tumor-free survival, without elevation of blood alpha-fetal protein (AFP) or human chorionic gonadotropin (HCG). One patient developed postoperative recurrence in the retroperitoneum 17 months after operation. After receiving two cycles of salvage therapy, his serum AFP and beta-HCG returned to normal ranges. Another patient had metastasis in the liver and lung six months after operation, but achieved complete response after six cycles of adjuvant cisplatin-based chemotherapy. Antegrade ejaculation was preserved in 96.8% of patients. The mean operative time was 175 vs. 143 min(P=0.002), and the blood loss was 200 vs.104 mL in the group with and without preoperative chemotherapy, respectively(P<0.001).
Modified RPLND achieves satisfactory results for stageI/II NSGCTs patients. It decreases damages to normal organs as well as causes less perioperative and postoperative complications compared to conventional PRLND.
腹膜后淋巴结清扫术（RPLND）是非精原细胞瘤性生殖细胞肿瘤（NSGCTs）的主要治疗方式之一。RPLND对于Ⅰ/Ⅱ期NSGCTs已取得相对较高的疗效。目前，传统RPLND术后并发症发生率较高。本研究旨在总结改良RPLND治疗Ⅰ/Ⅱ期NSGCTs的疗效，从而探索针对这些疾病的合理治疗策略。
回顾性分析2003年8月至2007年8月在中山大学肿瘤防治中心接受RPLND的31例Ⅰ/Ⅱ期NSGCTs患者的临床资料。所有病例在根治性睾丸切除术后接受改良RPLND。4例在RPLND前接受了2至3个周期的BEP（博来霉素、依托泊苷和顺铂）化疗。13例在初次RPLND后接受了1至5个周期的以顺铂为主的辅助化疗。
改良RPLND的平均手术时间为147分钟（范围120 - 200分钟），平均失血量为116毫升（范围50 - 300毫升）。送检病理检查的淋巴结平均数量为15个（范围3 - 40个）。15例确诊为腹膜后淋巴结转移，其中2例为纤维化。根据术后病理分期，Ⅰ期16例，ⅡA期6例，ⅡB期6例，ⅡC期3例。围手术期及术后均未发生并发症。平均随访时间为33个月，范围8至58个月。29例患者实现无瘤生存，血甲胎蛋白（AFP）及人绒毛膜促性腺激素（HCG）未升高。1例患者术后17个月腹膜后复发。接受2个周期挽救性治疗后，其血清AFP和β - HCG恢复至正常范围。另1例患者术后6个月出现肝肺转移，但在接受6个周期的以顺铂为主的辅助化疗后实现完全缓解。96.8%的患者保留了顺行射精功能。术前化疗组与未化疗组的平均手术时间分别为175分钟和143分钟（P = 0.002），失血量分别为200毫升和104毫升（P < 0.001）。
改良RPLND治疗Ⅰ/Ⅱ期NSGCTs患者取得了满意的效果。与传统PRLND相比，它减少了对正常器官的损伤，且围手术期及术后并发症更少。
