Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA, USA.
Ann Surg Oncol. 2012 Jul;19(7):2388-93. doi: 10.1245/s10434-012-2284-8. Epub 2012 Mar 7.
To evaluate the clinicopathologic characteristics of patients undergoing adjuvant surgery during postchemotherapy retroperitoneal lymph node dissection (PC-RPLND).
From 2004 to 2010, 85 testicular cancer patients underwent PC-RPLND by a single surgeon (S.D.). A bilateral template approach was utilized with nerve-sparing technique whenever feasible. The clinicopathologic and outcome of patients who underwent removal of any organ or structure during PC-RPLND were reviewed.
Of 85 patients undergoing PC-RPLND, 28 (33%) required adjuvant procedures. Thirteen (15%) required vascular procedures including cavotomy/caval resection in 6, aortic resection in 8, common iliac vessels resection in 4, and renal vessels resection/reimplant in 2. Twelve patients (14%) required adjuvant nephrectomy (ten of 12 left-sided). There was one ureteral resection with appendiceal substitution, one partial duodenectomy, two cholecystectomy, two thoracotomies, four liver resection/biopsy, and one neck dissection. There were eight early complications (28%), including vocal cord paralysis, brachial plexus injury, lower extremities compartment syndrome, thigh numbness, upper gastrointestinal bleeding, retroperitoneal hematoma, and alcohol withdrawal. No perioperative death was reported. Retroperitoneal pathology revealed mature teratoma in 11 patients (39%), fibrosis in 8 (28%), and viable germ cell tumor (GCT) in 9 (32%). A total of 75, 82, and 66% of patients with fibrosis, teratoma, and viable GCT, respectively, had no evidence of recurrence at a mean follow-up of 18 months.
Many patients undergoing PC-RPLND require adjuvant surgery, including vascular procedures and nephrectomy. The excellent outcomes associated with low operative morbidity and mortality validates such aggressive surgical approaches performed by experienced surgeons.
评估化疗后腹膜后淋巴结清扫术（PC-RPLND）期间接受辅助手术的患者的临床病理特征。
2004 年至 2010 年，由一位外科医生（S.D.）对 85 例睾丸癌患者进行了 PC-RPLND。只要可行，就采用双侧模板方法和神经保留技术。回顾了在 PC-RPLND 过程中切除任何器官或结构的患者的临床病理和结果。
在 85 例接受 PC-RPLND 的患者中，有 28 例（33%）需要辅助手术。13 例（15%）需要血管手术，包括 6 例腔静脉切开/切除术、8 例主动脉切除术、4 例髂总血管切除术和 2 例肾血管切除术/再植术。12 例（14%）患者需要辅助性肾切除术（12 例中有 10 例为左侧）。有 1 例输尿管切除术伴阑尾替代术、1 例部分十二指肠切除术、2 例胆囊切除术、2 例开胸术、4 例肝切除术/活检术和 1 例颈部清扫术。有 8 例早期并发症（28%），包括声带麻痹、臂丛神经损伤、下肢间隔综合征、大腿麻木、上消化道出血、腹膜后血肿和酒精戒断。无围手术期死亡报告。腹膜后病理学显示 11 例（39%）为成熟畸胎瘤、8 例（28%）为纤维化和 9 例（32%）为有活力的生殖细胞瘤（GCT）。纤维化、畸胎瘤和有活力的 GCT 患者的分别有 75%、82%和 66%在平均 18 个月的随访中无复发证据。
许多接受 PC-RPLND 的患者需要辅助手术，包括血管手术和肾切除术。这种积极的手术方法由经验丰富的外科医生实施，具有出色的结果和较低的手术发病率和死亡率。
