title: Retroperitoneal lymph node dissection in patients with high risk testicular cancer.
abstract: OBJECTIVE
  In patients with testicular cancer the percent of embryonal carcinoma and lymphovascular invasion in the primary tumor have been identified as risk factors for occult metastatic disease. We reviewed differences between primary and post-chemotherapy retroperitoneal lymph node dissection in patients at high risk.
  
  
  METHODS
  Patients who underwent retroperitoneal lymph node dissection at our institution from 1993 to 2006 were identified and the clinical charts were reviewed. A total of 247 patients with orchiectomy specimens containing greater than 30% embryonal carcinoma were identified and perioperative data were obtained.
  
  
  RESULTS
  Of 247 patients 133 (53%) had greater than 30% embryonal carcinoma, including 76 (57%) with combined lymphovascular invasion. Median followup was 3.49 years. Of the patients 76 (57%) and 57 (43%) underwent primary and post-chemotherapy retroperitoneal lymph node dissection, respectively, of whom most received bleomycin, etoposide and cisplatin. Positive lymph nodes were identified at surgery in 37 (49%) and 35 patients (61%) with primary and post-chemotherapy retroperitoneal lymph node dissection, respectively. Of patients with negative pathological findings at surgery surveillance computerized tomography postoperatively identified retroperitoneal masses in 2 (5%) and 3 (14%) of those who underwent a primary and a post-chemotherapy procedure, respectively. Operative data on the primary vs post-chemotherapy groups showed an estimated blood loss of 166 vs 371 cc, an operative time of 2.7 vs 3.3 hours and a hospital stay of 4.4 vs 4.7 days. There were no deaths in either group.
  
  
  CONCLUSIONS
  Patients with greater than 30% embryonal carcinoma with or without lymphovascular invasion are at significant risk for metastatic disease and they can be successfully treated with primary retroperitoneal lymph node dissection. Recurrence rates based on computerized tomography evaluation were low and similar between the chemotherapy and nonchemotherapy treated groups.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.forename: David W
authors.initials: DW
authors.lastname: McDermott
authors.forename: Winston
authors.initials: W
authors.lastname: Dock
authors.forename: Eamonn
authors.initials: E
authors.lastname: Bahnson
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Berry
authors.forename: Graeme S
authors.initials: GS
authors.lastname: Steele
authors.forename: Jerome P
authors.initials: JP
authors.lastname: Richie
mesh_terms: D000328:Adult; D000367:Age Factors; D018236:Carcinoma, Embryonal / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D009919:Orchiectomy / Q000379:methods; D011336:Probability; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult