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Primary Retroperitoneal Lymph Node Dissection as Treatment for Low-volume Metastatic Seminoma in a Population-based
Anna Thor1,2, Helene F S Negaard3, Anna Grenabo Bergdahl4,5
1Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden.
Background And Objective:
There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy.
Methods:
Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).
Key Findings And Limitations:
In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13-24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16-30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4-14). PFS was 90% (95% confidence interval: 0.86-1) and OS was 100% at 24 mo.
Conclusions And Clinical Implications:
RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.
Patient Summary:
In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.
Insights
Retroperitoneal lymph node dissection (RPLND) is a viable treatment for select low-stage seminoma patients, offering an alternative to chemotherapy with low complication and recurrence rates. This surgical approach may reduce long-term treatment morbidity.
Area of Science:
- Oncology
- Surgical Oncology
- Urologic Oncology
Background:
- Metastatic seminoma requires treatment to avoid long-term morbidity from standard cytotoxic therapies.
- There is a need for treatment options that minimize long-term side effects for low-volume metastatic seminoma.
- Retroperitoneal lymph node dissection (RPLND) is explored as a potentially less morbid alternative.
Purpose of the Study:
- To assess the oncological efficacy of RPLND in metastatic seminoma patients with limited retroperitoneal lymphadenopathy.
- To evaluate the surgical safety and complication rates associated with RPLND in this patient group.
- To determine the progression-free survival (PFS) and overall survival (OS) following RPLND.
Main Methods:
- A population-based cohort of 62 metastatic seminoma patients from Norway and Sweden (2019-2022) was analyzed.
- Patients with lymphadenopathy ≤3 cm, clinical stage IIA/B or relapsed CS I, underwent template RPLND (open or robot-assisted).
- Outcomes included surgical complications (Clavien-Dindo), PFS, and OS at 24 months.
Main Results:
- Robot-assisted RPLND was performed in 65% of patients.
- Grade III Clavien-Dindo complications occurred in 5% of patients; no higher-grade complications were observed.
- At a median follow-up of 23 months, 24-month PFS was 90% and OS was 100%, with a 10% recurrence rate.
Conclusions:
- RPLND is a safe and effective primary treatment option for selected seminoma patients with limited metastatic disease.
- The procedure demonstrates low complication and recurrence rates, potentially reducing long-term morbidity compared to chemotherapy.
- Surgery offers a valuable alternative to chemotherapy or radiation in managing limited metastatic seminoma.
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