title: Retroperitoneal vascular surgery for the treatment of giant growing teratoma syndrome.
abstract: OBJECTIVE
  To evaluate whether an aggressive surgical policy, which included vascular surgery with standard retroperitoneal lymph node dissection (RPLND), would be justified for managing bulky retroperitoneal growing teratoma syndrome (GTS).
  
  
  METHODS
  Data were collected retrospectively from a series of 12 patients who, from 1992 to 2010, underwent radical RPLND for bulky GTS (retroperitoneal mass≥10 cm in diameter). For complete resection, vascular procedures and nephrectomy were performed.
  
  
  RESULTS
  Median tumor diameter was 100 mm before and 140 mm (range 100-300) after chemotherapy. Two patients underwent iterative RPLND. In addition to RPLND, patients underwent aortic section with aortic anastomosis (n=6), inferior vena cava resection (n=3), both the latter and the former (n=1), and aortic graft with left nephrectomy (n=2). There were no operative deaths; 3 patients had complications (25%), but none were related to extended procedures. The median hospital stay was 15 days. Median follow up was 59 months (range 10-162). One patient died of metastatic cutaneous melanoma 112 months after RPLND, 10 patients survived and are disease-free, and one patient had a para-aortic recurrence.
  
  
  CONCLUSIONS
  A 100% complete resection rate, long-term survival, no mortality, and acceptable morbidity were achieved when vascular surgery and left nephrectomy were combined with standard RPLND for bulky GTS.
authors.affiliation: Department of Surgery, Léon Bérard Cancer Center, Lyon, France. stella@lyon.fnclcc.fr
authors.forename: Mattia
authors.initials: M
authors.lastname: Stella
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gandini
authors.forename: Pierre
authors.initials: P
authors.lastname: Meeus
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
authors.forename: Aude
authors.initials: A
authors.lastname: Flechon
authors.forename: Claire
authors.initials: C
authors.lastname: Cropet
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Droz
authors.forename: Michel
authors.initials: M
authors.lastname: Rivoire
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000601:surgery*; D014408:Biomarkers, Tumor / Q000097:blood; D001761:Bleomycin / Q000008:administration & dosage; D019917:Blood Vessel Prosthesis Implantation; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009392:Nephrectomy; D012186:Retroperitoneal Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D012189:Retrospective Studies; D013724:Teratoma / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D013736:Testicular Neoplasms / Q000601:surgery; D047368:Tumor Burden; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D014682:Vena Cava, Inferior / Q000601:surgery*; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin