Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey.
Clin Genitourin Cancer. 2012 Sep;10(3):185-9. doi: 10.1016/j.clgc.2012.04.002. Epub 2012 Jun 7.
Retroperitoneal lymph node dissection is an important treatment modality in nonseminomatous germ cell tumors of the testis. However, the role of more limited surgical approaches such as resection of enlarged lymph nodes only is still controversial.
Between January 1991 and December 2010, charts of 94 patients who underwent resection of enlarged retroperitoneal lymph nodes alone were reviewed. Pathologic findings, local recurrence, and adverse effects were noted after this surgical approach.
The median age was 25.5 years. Twenty-one (22.6%) patients had lung metastasis, and 5 (5.4%) patients had nonregional lymph node metastasis at the initial visit. Eighty-seven (91.6%) patients received chemotherapy after inguinal orchiectomy, and the other patients had mass resection only for enlarged lymph nodes without prior chemotherapy. In patients who had chemotherapy before surgery, the median retroperitoneal lymph node size before and after chemotherapy cycles was 55 mm and 32.5 mm, respectively. The pathologic assessment of retroperitoneal masses revealed mature teratoma in 51.6% (n = 47) of patients, viable carcinoma in 20.9% (n = 19) of patients, and necrosis or fibrosis in 27.5% (n = 25) of patients. The median follow-up time was 60.2 months (range, 2.7-334.8 months). During follow-up, 5 (5.4%) patients had radiologic relapse at the retroperitoneal area, and 3 patients developed systemic metastases. Six (6.4%) patients died of their disease, 2 (2.1%) patients were alive with disease, 86 (91.5%) patients were healthy at the last follow-up. Ejaculation status was recorded in 56 patients. Antegrade ejaculation had preserved in 53 (94.6%) of these patients.
Resection of enlarged lymph node metastases alone is a reasonable treatment option for patients with nonseminomatous germ cell tumors.
腹膜后淋巴结清扫术是睾丸非精原细胞瘤生殖细胞肿瘤的重要治疗方法。然而，对于更局限的手术方法，如仅切除肿大的淋巴结，其作用仍存在争议。
1991 年 1 月至 2010 年 12 月，对 94 例仅行腹膜后肿大淋巴结切除术的患者的病历进行了回顾。记录了该手术方法后的病理发现、局部复发和不良反应。
中位年龄为 25.5 岁。21 例（22.6%）患者有肺转移，5 例（5.4%）患者在初诊时有非区域淋巴结转移。87 例（91.6%）患者在腹股沟睾丸切除术后继发化疗，其他患者仅因淋巴结肿大而未行化疗行肿块切除术。在术前接受化疗的患者中，化疗前后腹膜后淋巴结大小中位数分别为 55mm 和 32.5mm。腹膜后肿块的病理评估显示，51.6%（n=47）的患者为成熟畸胎瘤，20.9%（n=19）的患者为有活性的癌，27.5%（n=25）的患者为坏死或纤维化。中位随访时间为 60.2 个月（范围 2.7-334.8 个月）。随访期间，5 例（5.4%）患者腹膜后区域出现影像学复发，3 例患者发生全身转移。6 例（6.4%）患者死于疾病，2 例（2.1%）患者疾病仍在持续，86 例（91.5%）患者在最后一次随访时健康状况良好。56 例患者记录了射精情况，53 例（94.6%）患者保留了顺行射精。
对于非精原细胞瘤生殖细胞肿瘤患者，仅切除肿大的淋巴结转移是一种合理的治疗选择。
