Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for advanced nonseminomatous germ cell tumors (GCTs) aims to resect all remaining metastatic tissue. Resection of adjacent visceral or vascular organs is commonly performed for complete resection. Resection of organs harboring only necrosis results in relevant overtreatment. The study aimed to describe the frequency of metastatic involvement of resected organs with teratoma or viable cancer and to analyze perioperative complications and relapse-free survival (RFS).
In a 2-center study, we reviewed a cohort of 1204 patients who underwent PC-RPLND between 2008 and 2021 and identified 242 (20%) cases of adjunctive surgery during PC-RPLND. We analyzed the removed adjacent structures and the pathohistological presence of GCT elements in the resected organs: viable GCT, teratoma or necrosis/fibrosis. Surgery-associated complications were reported according to the Clavien‒Dindo classification.
Viable, teratoma and necrosis were present in 54 (22%), 94 (39%) and 94 (39%), respectively, of all patients with adjunctive resection of adjacent organs. Vascular resections or reconstructions (n = 112; viable: 23%, teratoma: 41%, necrosis: 36%) were performed most frequently, followed by nephrectomies (n = 77; viable: 29%, teratoma: 39%, necrosis: 33%). Perioperative complications of grade ≥ IIIa occurred in 6.6% of all patients, with no difference between the viable and teratoma/necrosis groups (P = .1). A total of 76 patients have been followed without a relapse for at least 36 months. Median follow-up of the whole cohort was 22 months (7, 48). Patients with viable/teratoma in the resected specimens had a significantly increased risk of recurrence by 5-years compared to patients with only necrosis (19% vs 59% vs 81%, P < .001).
This study shows that 33 to 40% of all resections of adjacent organs do not harbor teratoma or viable germ cell tumor. This highlights the need for better patient selection for these complex patients.
The Journal of urology. 2023 Dec 12 [Epub ahead of print]
Tim Nestler, Pia Paffenholz, David Pfister, Justine Schoch, Alessandro Nini, Andreas Hiester, Peter Albers, Axel Heidenreich
Department of Urology and Uro-Oncology, University Hospital of Cologne, Cologne, Germany., Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany., Department of Urology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.