title: Repeat retroperitoneal lymph-node dissection after chemotherapy for metastatic testicular germ cell tumour.
abstract: OBJECTIVE
  To examine the operative findings, histopathology and clinical outcome of patients undergoing repeat retroperitoneal lymph node dissection (RPLND) after initial chemotherapy and RPLND (PC-RPLND) for metastatic testicular germ cell tumour (GCT), as a small proportion relapse or have residual disease after incomplete resection in the lung, retrocrural or pelvic nodes, and retroperitoneum.
  
  
  METHODS
  Between September 1992 and May 2006, 359 patients had PC-RPLND under the care of one surgeon, 54 of which were repeat procedures. We compared the long-term outcome between those having primary and those having repeat PC-RPLND.
  
  
  RESULTS
  The median (range) time from original to repeat surgery was 2.4 (0.25-26.5) years, and the median follow-up after the repeat procedure was 5.8 (0.08-12.9) years. There was no difference in survival between patients requiring only one PC-RPLND and those having a repeat procedure (P = 0.592). The most frequent sites of recurrent disease were: behind the great vessels/para-aortic areas (38, 46%), in the suprahilar region (18, 18%), in the retrocrural area (16, 19%), in the pelvic nodes (10, 12%) and in the lung (one, 1%). The most common pathological findings in the repeat PC-RPLNDs were differentiated teratoma (19, 35%), malignant teratoma undifferentiated (nine, 17%), adenocarcinoma (eight, 15%) and necrotic tissue (five, 9.2%).
  
  
  CONCLUSIONS
  Although a small proportion of patients with metastatic GCT might require repeat PC-RPLND, there is no difference in survival between this group and those having one PC-RPLND. However, to avoid cancer recurrence and reoperation, it is crucial that the first PC-RPLND is careful and complete, preferably done in a centre with expertise in this procedure.
authors: Charing Cross Hospital, London, UK. s.willis@imperial.ac.uk
authors: Susan F
authors: SF
authors: Willis
authors: Mathias
authors: M
authors: Winkler
authors: Philip
authors: P
authors: Savage
authors: Michael J
authors: MJ
authors: Seckl
authors: Timothy J
authors: TJ
authors: Christmas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018365:Neoplasm, Residual; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D012086:Reoperation; D012187:Retroperitoneal Space; D012307:Risk Factors; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents