Universität zu Köln

John, Patricia, Albers, Peter, Hiester, Andreas and Heidenreich, Axel (2020). Retroperitoneal lymph node dissection in testicular germ cell tumours: indications, complications and special cases. Aktuelle Urol., 51 (5). S. 475 - 482. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1438-8820

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Abstract

Retroperitoneal lymph node dissection is an integral part of the stage-adapted therapy of germ cell tumours. Different approaches of retroperitoneal lymph node dissection are performed based on various indications. Nerve-sparing retroperitoneal lymph node dissection as a primary therapy option in non-seminomatous germ cell tumours in clinical stage I disease should be performed using a risk-adapted approach. Minor complications like infections of operative wounds, lymphoceles and paralytic ileus are described in about 14% of patients, major complications like chylous ascites and pulmonary artery embolism in 5,4% of patients. The most common long-term complication is retrograde ejaculation. Antegrade ejaculation rates of over 90% can be achieved with a nerve-sparing attempt. Post-chemotherapy retroperitoneal lymph node dissection is an integral part of the multimodality treatment of retroperitoneal residual masses after chemotherapy. For residual masses with a diameter of > 3 cm in advanced seminoma patients, FDG-PET is a reliable indicator for decision-making on retroperitoneal lymph node dissection. Residual retroperitoneal tumour masses appear in about 30% of patients with non-seminomatous germ cell tumours. These masses should be resected completely, irrespectively of their size, in patients with negative tumour markers or plateauing tumour markers. Post-chemotherapy lymph node dissection is a challenging procedure and should be performed at referral centres. In 25% of patients, resection of adjunctive organs is necessary in post-chemo lymph node dissection. Affection of abdominal aorta is described in 6 - 10% of all cases, affection of inferior vena cava in about 2% of cases. Post-chemo lymph node dissection is associated with a higher complication rate than nerve-sparing primary retroperitoneal lymph node dissection, including a significantly higher intraoperative blood loss and a significantly higher transfusion rate. With rates of 2 - 7%, chylous ascites occurs more often in post-chemo retroperitoneal lymph node dissection. Antegrade ejaculation can be preserved in up to 85% of patients. To preserve antegrade ejaculation and reduce morbidity, a nerve-sparing approach and template reduction in post-chemo retroperitoneal lymph node dissection is crucial and should be performed when possible.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code John, Patricia UNSPECIFIED UNSPECIFIED UNSPECIFIED Albers, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hiester, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-322040
DOI:	10.1055/a-1176-9796
Journal or Publication Title:	Aktuelle Urol.
Volume:	51
Number:	5
Page Range:	S. 475 - 482
Date:	2020
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1438-8820
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STAGE-I; RISK-FACTORS; PATIENT SELECTION; TESTIS CANCER; CHEMOTHERAPY; MANAGEMENT; LYMPHADENECTOMY; HISTOLOGY; RESECTION; SURGERY Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32204