Herr H W
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Br J Urol. 1997 Oct;80(4):653-7. doi: 10.1046/j.1464-410x.1997.00427.x.
To evaluate morbidity and relapse in patients with advanced testis cancer who underwent a post-chemotherapy resection of a residual mass and a limited retroperitoneal lymph node dissection.
A total of 62 patients underwent complete resection of retroperitoneal masses after chemotherapy and a limited lymph node dissection if frozen sections of the mass showed necrosis (37 patients) or a bilateral dissection if the frozen section indicated viable germ cell tumour or teratoma (25 patients).
With a median follow-up of 6 years, 14 (23%) patients relapsed, but only one within the retroperitoneum (teratoma) after a limited lymphadenectomy. There was a concordance of 89% between the frozen section of the post-chemotherapy mass and the permanent-section histological diagnosis of the entire lymphadenectomy specimen. Of the 37 patients whose masses showed necrosis on frozen section, three had viable germ cell tumour and one had teratoma on final histology. In all four false-negative cases, residual tumour was confined to the resected mass. Six patients (10%) had surgical complications (one after limited and five after bilateral lymph node dissection).
The surgical resection of all residual masses after chemotherapy, followed by limited retroperitoneal lymphadenectomy if frozen-section analysis shows necrosis, is a safe approach in selected patients with advanced testicular cancer.
评估晚期睾丸癌患者在接受化疗后残留肿块切除及有限的腹膜后淋巴结清扫术后的发病率和复发情况。
共有62例患者在化疗后接受了腹膜后肿块的完整切除，若肿块冰冻切片显示坏死，则进行有限的淋巴结清扫（37例患者）；若冰冻切片显示为存活的生殖细胞肿瘤或畸胎瘤，则进行双侧清扫（25例患者）。
中位随访6年，14例（23%）患者复发，但有限淋巴结清扫术后仅1例在腹膜后复发（畸胎瘤）。化疗后肿块的冰冻切片与整个淋巴结清扫标本的永久切片组织学诊断的一致性为89%。在37例肿块冰冻切片显示坏死的患者中，最终组织学检查有3例存在存活的生殖细胞肿瘤，1例为畸胎瘤。在所有4例假阴性病例中，残留肿瘤局限于切除的肿块内。6例患者（10%）出现手术并发症（1例发生在有限淋巴结清扫术后，5例发生在双侧淋巴结清扫术后）。
对于部分晚期睾丸癌患者，化疗后切除所有残留肿块，若冰冻切片分析显示坏死则随后进行有限的腹膜后淋巴结清扫，是一种安全的方法。
