Christmas T J, Doherty A P, Rustin G J, Seckl M J, Newlands E S
Department of Urology, Charing Cross Hospital, London, UK.
Br J Urol. 1998 Feb;81(2):301-8. doi: 10.1046/j.1464-410x.1998.00509.x.
To evaluate the efficacy and safety of extraperitoneal surgical approaches for the removal of residual masses of metastatic germ cell tumours in men after chemotherapy.
A series of 75 men (median age 32 years) with metastatic germ cell tumours of testicular (n = 63) or extragonadal (n = 12) origin, who had been treated with an intensive course of platinum-based chemotherapy, were found to have residual tumour masses. Extraperitoneal surgical approaches were used on 80 occasions to excise these masses. A thoraco-abdominal extraperitoneal approach (n = 71) was used for large masses and those with intrathoracic metastases while smaller retroperitoneal masses were removed through 12th rib (n = 5) or Rutherford-Morrison (n = 4) extraperitoneal approaches.
Complete macroscopic clearance of residual masses within the thorax and retroperitoneum was achieved in all cases. The median blood loss was 0.8 L and the median in-patient stay was 7 days. Complications included chest infection in four cases. Two patients died about 4 weeks after surgery, one from septic pericarditis and another after an epileptic fit secondary to brain metastases. Eleven patients have developed tumour recurrence, five of whom have died from disseminated disease. Hence the survival rate and disease-free survival rate are 91% and 83%, respectively, with a median follow-up of 22 months.
The thoraco-abdominal extraperitoneal surgical approach for retroperitoneal lymph node dissection after chemotherapy for testicular cancer is safe and has some advantages over anterior approaches, allowing synchronous removal of intrathoracic disease, improved access to nodes above and behind the renal vessels and more rapid post-operative recovery.
评估腹膜外手术方法在化疗后男性转移性生殖细胞肿瘤残留肿块切除中的疗效和安全性。
75名男性（中位年龄32岁），原发于睾丸（n = 63）或性腺外（n = 12）的转移性生殖细胞肿瘤，接受了强化铂类化疗后发现有残留瘤块。共进行了80次腹膜外手术切除这些肿块。对于较大肿块及有胸内转移的肿块采用胸腹联合腹膜外手术入路（n = 71），较小的腹膜后肿块则通过第12肋（n = 5）或卢瑟福-莫里森（n = 4）腹膜外入路切除。
所有病例均实现了胸腔和腹膜后残留肿块的完全宏观清除。中位失血量为0.8升，中位住院时间为7天。并发症包括4例肺部感染。两名患者术后约4周死亡，一名死于感染性心包炎，另一名死于脑转移继发癫痫发作。11名患者出现肿瘤复发，其中5名死于播散性疾病。因此，中位随访22个月时，生存率和无病生存率分别为91%和83%。
睾丸癌化疗后腹膜后淋巴结清扫采用胸腹联合腹膜外手术入路是安全的，与前路手术相比有一些优势，可同步切除胸内病变，改善肾血管上方和后方淋巴结的暴露，且术后恢复更快。
