Modified retroperitoneal lymph node dissection for post-chemotherapy residual tumour: a long-term update

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Metastatic non-seminomatous germ cell tumors (NSGCT) often require post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND).
• Previous outcomes of modified-template PC-RPLND were reported with limited follow-up.
• Long-term efficacy data is crucial for refining surgical strategies in NSGCT management.

Purpose of the Study:

• To provide a long-term update on the outcomes of modified-template PC-RPLND.
• To assess the durability and safety of this surgical approach in selected NSGCT patients.
• To address previous criticisms regarding short follow-up periods.

Main Methods:

• A cohort of 100 patients with NSGCT and residual retroperitoneal tumor after chemotherapy underwent modified PC-RPLND between 1991 and 2004.
• Data was collected from a prospectively managed institutional testicular cancer database.
• Long-term follow-up was obtained, with a median follow-up of 125 months.

Main Results:

• The 5- and 10-year recurrence-free survival rates were 93% and 92%, respectively.
• The overall survival at 10 years was 99%.
• Seven patients experienced recurrence, all outside the boundaries of a full-bilateral template dissection, with the chest being the most common site.

Conclusions:

• Modified-template PC-RPLND demonstrates durable long-term efficacy in appropriately selected NSGCT patients with low-volume disease.
• This approach is associated with a low risk of in-field recurrences.
• Long-term follow-up confirms the safety and effectiveness of modified-template RPLND for NSGCT.