title: Is retroperitoneal histology predictive of liver histology at concurrent post-chemotherapy retroperitoneal lymph node dissection and hepatic resection?
abstract: OBJECTIVE
  We identified factors predicting liver histology in patients with nonseminomatous germ cell tumor undergoing concurrent post-chemotherapy retroperitoneal lymph node dissection and liver resection.
  
  
  METHODS
  We reviewed the Indiana University testis cancer database to identify all patients with nonseminomatous germ cell tumor and liver metastasis who underwent post-chemotherapy retroperitoneal lymph node dissection and liver resection between 1976 and 2006.
  
  
  RESULTS
  A total of 59 patients met study inclusion criteria. Necrosis, teratoma and cancer were identified in 31%, 46% and 24% of retroperitoneal specimens, and in 73%, 17% and 10% of liver specimens, respectively. Concordance between retroperitoneal and liver histology was 49% overall, including 94% for necrosis, 26% for teratoma and 36% for cancer. Liver necrosis alone was found in 94%, 70% and 50% of patients with retroperitoneal necrosis, teratoma and cancer, respectively.
  
  
  CONCLUSIONS
  The overall rate of histological discordance between retroperitoneal and liver histology was 51% with 73% of all liver specimens containing necrosis only. Retroperitoneal necrosis is highly predictive of hepatic necrosis (94%). Management for liver lesions at post-chemotherapy retroperitoneal lymph node dissection must be individualized. Observation may be warranted for liver lesions requiring complicated hepatic surgery regardless of retroperitoneal pathology.
authors.affiliation: Departments of Urology, Surgery and Medicine, Indiana University, Indianapolis, Indiana, USA. njacobse@ualberta.ca
authors.forename: Niels-Erik B
authors.initials: NE
authors.lastname: Jacobsen
authors.forename: Stephen D W
authors.initials: SD
authors.lastname: Beck
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Jacobson
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Einhorn
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D009336:Necrosis; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D011237:Predictive Value of Tests; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult