腹腔镜与开放经化疗后腹膜后淋巴结清扫术治疗晚期睾丸生殖细胞肿瘤：单中心分析。
Laparoscopic and open postchemotherapy retroperitoneal lymph node dissection in patients with advanced testicular cancer--a single center analysis.
机构信息
Charité University Medicine Berlin, Department of Urology, Berlin, Germany.
出版信息
BMC Urol. 2012 May 31;12:15. doi: 10.1186/1471-2490-12-15.
BACKGROUND
The open approach represents the gold standard for postchemotherapy retroperitoneal lymph node dissection (O-PCLND) in patients with residual testicular cancer. We analyzed laparoscopic postchemotherapy retroperitoneal lymph node dissection (L-PCLND) and O-PCLND at our institution.
METHODS
Patients underwent either L-PCLND (n = 43) or O-PCLND (n = 24). Categorical and continuous variables were compared using the Fisher exact test and Mann-Whitney U test respectively. Overall survival was evaluated with the log-rank test.
RESULTS
Primary histology was embryonal cell carcinomas (18 patients), pure seminoma (2 cases) and mixed NSGCTs (47 patients). According to the IGCCCG patients were categorized into "good", "intermediate" and "poor prognosis" disease in 55.2%, 14.9% and 20.8%, respectively. Median operative time for L-PCLND was 212 min and 232 min for O-PCLND (p = 0.256). Median postoperative duration of drainage and hospital stay was shorter after L-PCLND (0.0 vs. 3.5 days; p < 0.001 and 6.0 vs. 11.5 days; p = 0.002). Intraoperative complications occurred in 21.7% (L-PCLND) and 38.0% (O-PCLND) of cases with 19.5% and 28.5% of Clavien Grade III complications for L-PCLND and O-PCLND, respectively (p = 0.224). Significant blood loss (>500 ml) was almost equally distributed (8.6% vs. 14.2%: p = 0.076). No significant differences were observed for injuries of major vessels and postoperative complications (p = 0.758; p = 0.370). Tumor recurrence occurred in 8.6% following L-PCLND and in 14.2% following O-PCLND with a mean disease-free survival of 76.6 and 89.2 months, respectively. Overall survival was 83.3 and 95.0 months for L-PCNLD and O-PCLND, respectively (p = 0.447).
CONCLUSIONS
L-PCLND represents a safe surgical option for well selected patients at an experienced center.
背景
开放手术是化疗后腹膜后淋巴结清扫术（O-PCLND）治疗残留睾丸癌患者的金标准。我们分析了本机构的腹腔镜化疗后腹膜后淋巴结清扫术（L-PCLND）和 O-PCLND。
方法
患者接受 L-PCLND（n=43）或 O-PCLND（n=24）治疗。使用 Fisher 精确检验和 Mann-Whitney U 检验分别比较分类和连续变量。使用对数秩检验评估总生存率。
结果
原发性组织学为胚胎细胞癌（18 例）、单纯精原细胞瘤（2 例）和混合 NSGCT（47 例）。根据 IGCCCG，患者分别被归类为“良好”、“中等”和“预后不良”疾病，分别为 55.2%、14.9%和 20.8%。L-PCLND 的中位手术时间为 212 分钟，O-PCLND 的中位手术时间为 232 分钟（p=0.256）。L-PCLND 的术后引流和住院时间更短（0.0 与 3.5 天；p<0.001 和 6.0 与 11.5 天；p=0.002）。21.7%（L-PCLND）和 38.0%（O-PCLND）的病例发生术中并发症，L-PCLND 和 O-PCLND 的 Clavien 分级 III 并发症分别为 19.5%和 28.5%（p=0.224）。明显失血（>500ml）的分布几乎相同（8.6%比 14.2%：p=0.076）。主要血管损伤和术后并发症无显著差异（p=0.758；p=0.370）。L-PCLND 后肿瘤复发率为 8.6%，O-PCLND 后肿瘤复发率为 14.2%，无病生存率分别为 76.6 和 89.2 个月。L-PCNLD 和 O-PCLND 的总生存率分别为 83.3%和 95.0%（p=0.447）。
结论
对于经验丰富中心的精选患者，L-PCLND 是一种安全的手术选择。
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