Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
BJU Int. 2010 Sep;106(6):779-85. doi: 10.1111/j.1464-410X.2009.09175.x. Epub 2010 Jan 19.
To determine whether conformity to standard recommendations of retroperitoneal lymph node dissection (RPLND) after chemotherapy for testicular and primary retroperitoneal nonseminomatous germ cell tumours (NSGCT) and completeness of surgical excision have an effect on oncological outcome.
This was a retrospective study of patients with testicular and primary retroperitoneal NSGCT, with initial involvement of RPLNs, treated between June 1992 and December 2002 in one institution. We reviewed the clinical, surgical and histological charts of 151 such patients who had a RPLND after first-line platinum-based chemotherapy. The recommendations used to define conformity to RPLND standards were: the indication based on initial and residual lymph node size, shrinkage, extension of dissection and completeness of resection.
RPLND conformed to standard recommendations in 70 of the 151 (46%) patients. Conformity was complete for the surgeon who operated on 48 patients and was 26% of the others. Fifteen patients (10%) relapsed in the retroperitoneum, 14 of whom had initial lymph nodes of > or =5 cm. Two patients (3%) relapsed in the group of 70 patients with conformed and complete RPLND, vs 13 (16%) in the 81 with conformed but incomplete resection or with non-conformed and complete or incomplete RPLND. After a median (range) follow-up of 77 (1.3-186.5) months 132 patients were alive with no evidence of disease, 18 died and one was alive with progressive disease. The limitations of this study were the relatively few patients and that it was retrospective.
There was conformity of RLNPD to the recommendations, and completeness of resection, in half of the patients operated; this might have an effect on oncological outcome. Our data suggest that patients should be treated in tertiary centres.
确定化疗后腹膜后淋巴结清扫（RPLND）是否符合睾丸和原发性腹膜后非精原细胞瘤生殖细胞肿瘤（NSGCT）的标准建议以及手术切除的完整性对肿瘤学结果有影响。
这是对一家机构 1992 年 6 月至 2002 年 12 月期间接受一线铂类化疗后进行 RPLND 的 151 例睾丸和原发性腹膜后 NSGCT 患者的回顾性研究。我们回顾了 151 例患者的临床、手术和组织学图表，这些患者均为初始累及 RPLN 的 NSGCT 患者。我们使用以下标准来定义 RPLND 符合标准建议：根据初始和残留淋巴结大小、缩小、扩展手术和切除完整性的适应证。
151 例患者中有 70 例（46%）符合 RPLND 标准建议。进行手术的外科医生完全符合标准，而其他医生的符合率为 26%。15 例（10%）患者在腹膜后复发，其中 14 例初始淋巴结大于或等于 5cm。2 例（3%）在符合和完全 RPLND 的 70 例患者中复发，而在符合但不完全切除或不符合但完全或不完全 RPLND 的 81 例患者中复发 13 例（16%）。中位（范围）随访 77（1.3-186.5）个月后，132 例患者无疾病存活，18 例死亡，1 例进展性疾病存活。本研究的局限性在于患者数量相对较少且为回顾性研究。
一半以上接受手术的患者的 RPLND 符合建议，且切除完整，这可能对肿瘤学结果有影响。我们的数据表明，患者应在三级中心接受治疗。
