Universität zu Köln

Heidenreich, A., Haidl, F., Paffenholz, P., Pape, Ch., Neumann, U. and Pfister, D. (2017). Surgical management of complex residual masses following systemic chemotherapy for metastatic testicular germ cell tumours. Ann. Oncol., 28 (2). S. 362 - 368. OXFORD: OXFORD UNIV PRESS. ISSN 1569-8041

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Abstract

Background: Post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) represents the treatment of choice in patients with residual masses following chemotherapy for metastatic germ cell tumours. Involvement of major retroperitoneal vessels or thoracic/lumbar spine is rare and challenging but needs complete resection for curative intent. We report on our experience in the management of such complex cases. Patients and methods: A total of 185 patients underwent PC-RPLND and we identified 25 (13.5%) patients who needed complex adjunctive vascular (n = 16, 8.6%), skeletal (n = 5, 2.7%) and pancreaticoduodenal (n = 4, 2.2%) surgeries. We performed a retrospective analysis of treatment-associated complications according to the Clavien-Dindo classification. Progression-free, cancer-specific and overall survival was calculated. Results: All patients were of intermediate/poor prognosis according to IGCCCG. Median tumour diameter at time of surgery was 18.6 (9.0-35) cm. Sixteen (8.6%) underwent vascular surgery including aortic resection and replacement, complete or partial resection of the inferior vena cava with thrombectomy, and resection and replacement of the iliac vessels. In five patients, 1-2 metastatic lumbar vertebral bodies were resected, stabilized and replaced. Four patients underwent en-bloc resection of a suprahilar mass with pancreas and duodenum. Pathohistology revealed vital cancer in five patients; teratoma and malignant somatic transformation was identified in 12 and 6 patients, respectively. Complications occurred more often in the group of complex RPLND (41.7 versus 7.2%, P = 0.02) with the majority representing grade I-IIa. After a median follow-up of 28.5 months, four patients developed recurrent disease and one patient died of the disease. Conclusions: Few patients with advanced GCT need complex vascular, skeletal or intestinal surgery in an interdisciplinary setting with good functional and oncological outcome. Due to the complexity, treatment should be performed at specialized centres.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heidenreich, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Haidl, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Paffenholz, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pape, Ch. UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumann, U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-241505
DOI:	10.1093/annonc/mdw605
Journal or Publication Title:	Ann. Oncol.
Volume:	28
Number:	2
Page Range:	S. 362 - 368
Date:	2017
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1569-8041
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LYMPH-NODE DISSECTION; RETROPERITONEAL LYMPHADENECTOMY; MALIGNANT-TRANSFORMATION; TESTIS CANCER; VENA-CAVA; RESECTION; CLASSIFICATION; COMPLICATIONS; TERATOMA; NEPHRECTOMY Multiple languages Oncology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24150