[Caval involvement in advanced-stage non-seminoma testicular tumors: surgical strategy and long-term results].
OBJECTIVE
The involvement of vena cava by residual masses after cytoreductive chemotherapy for bulky metastatic germ cell tumors is a rare but possible event. It could ensue by tumor invasion of the inferior vena cava (IVC), venous or neoplastic thrombosis, or by close adherence and encasement of IVC by scar tissue containing fibrosis or cancer; it usually occurs in right testicular neoplasms. In this study we evaluated a group of nine over 86 patients who underwent IVC (and possibly aortic) surgery for post-chemotherapy residual masses and we assessed long term oncological and functional efficacy of the procedure.


METHODS
Between 1980 and 1997, 86 patients underwent retroperitoneal lymphadenectomy (RPLND) after induction or additional salvage chemotherapy. A subgroup of nine patients, all with primary tumors of the right testis in stage II C to III, showed evidence of caval involvement, four had caval thrombosis, seven exhibited caval invasion; in one case the IVC was displaced and compressed with no clear evidence of infiltration. Surgical management was: three en-bloc and four restricted vena caval resection and two thrombectomy.


RESULTS
Of nine patients who underwent IVC surgery, six are alive and have no evidence of disease (follow-up 43-207 months), while three patients deceased for early progression (6-10 months). There were no major surgical complications: only one patient exhibited a significant lymphedema as a result of the primary vascular involvement or of following IVC surgery.


CONCLUSIONS
IVC resection is sometimes necessary to complete RPLND of residual masses: it might be crucial to gain oncological clearance, with moderate long term morbidity even for extensive vena cava resections. Among patients eligible for postchemotherapy RPLND, caval involvement selects a higher risk subgroup that should be addressed to medical centers experienced in IVC neoplastic involvement.
Tavolini
Ivan Matteo
IM
Clinica Urologica, Università, Azienda Ospedaliera di Padova, Padova, Italy. tavolini@unipd.it
Norcen
Marco
M
Oliva
Gaetano
G
Nigro
Filippo
F
Benedetto
Giuseppe
G
Mazzariol
Chiara
C
Bassi
Pierfrancesco
P
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003097:Collateral Circulation; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004407:Dysgerminoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D011859:Radiography; D012187:Retroperitoneal Space; D016879:Salvage Therapy; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017131:Thrombectomy; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery; D014747:Vinblastine / Q000008:administration & dosage
D001761:Bleomycin; D014747:Vinblastine; D002945:Cisplatin