Incidence of metastatic nonseminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection.
BACKGROUND
Modified template retroperitoneal lymph node dissections (RPLND) have become increasing applied in the postchemotherapy (PC) setting. We evaluated our experience with PC-RPLND to determine the incidence of disease extending outside the boundaries of a modified PC-RPLND.


METHODS
From 1989 through 2003, a total of 532 men underwent PC-RPLND for metastatic nonseminomatous germ cell tumor (NSGCT). Of these, 269 (51%) had either viable germ cell tumor (GCT) or teratoma present in the RPLND specimen. After Institutional Review Board approval, clinical and pathologic data were obtained from our prospective surgical database. The incidence of retroperitoneal disease outside the boundaries of five modified templates was reported for the presence of viable GCT or teratoma.


RESULTS
Of the 269 patients with viable GCT or teratoma, 20 to 86 (7% to 32%) patients had evidence of extratemplate retroperitoneal disease, depending on the boundaries of the modified template. There was no difference in the histologic distribution for patients with disease confined to or outside of the modified templates. Despite the absence of preoperative radiographic evidence of disease outside the boundaries of the Testicular Tumor Study Group template, the incidence of extratemplate metastasis for men with residual retroperitoneal masses less than 1, 1 to 2, 2 to 5, and more than 5 cm was two of 24 (8%), seven of 38 (18%), 27 of 92 (29%), and 14 of 55 (25%), respectively.


CONCLUSIONS
Our data suggest a bilateral RPLND is a prudent approach for the management of men with metastatic NSGCT after chemotherapy, given that at least 7% to 32% of men will have teratoma or viable GCT outside the boundaries of a modified template.
Carver
Brett S
BS
Department of Urology and Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. carverb@mskcc.org
Shayegan
Bobby
B
Eggener
Scott
S
Stasi
Jason
J
Motzer
Robert J
RJ
Bosl
George J
GJ
Sheinfeld
Joel
J
D000970:Antineoplastic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D018365:Neoplasm, Residual / Q000453:epidemiology* / Q000473:pathology; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D012186:Retroperitoneal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D012187:Retroperitoneal Space; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control; D013724:Teratoma / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D014481:United States / Q000453:epidemiology
D000970:Antineoplastic Agents