title: Pathological findings after primary chemotherapy in patients undergoing simultaneous orchidectomy and retroperitoneal lymph node dissection for advanced germ cell tumours.
abstract: OBJECTIVE
  To determine the differential response to systemic chemotherapy in patients undergoing simultaneous orchidectomy and retroperitoneal lymph node dissection (RPLND) after chemotherapy for metastatic testicular cancer.
  
  
  METHODS
  Patients who underwent simultaneous RPLND and orchidectomy after chemotherapy were identified from our clinical databases. Postoperative pathological findings and patient characteristics were reviewed.
  
  
  RESULTS
  In all, 42 patients were identified. After chemotherapy, necrosis, teratoma and cancer were identified in 25 (59.5%), 14 (33.3%) and three (7.1%) RPLN specimens and 15 (35.7%), 15 (35.7%) and 12 (28.6%) orchidectomy specimens respectively. Of the 25 patients with necrotic RPLN specimens 12 (48.0%) had active disease within the orchidectomy specimen (eight invasive cancer and four mature teratoma). The overall histological discordance rate was 38.1%. Findings in the orchidectomy specimens were more aggressive than those in the RPLN specimens (i.e. cancer worse than teratoma, which is worse than necrosis) in 33.3%.
  
  
  CONCLUSIONS
  There is significant disparity between orchidectomy and RPLND findings with viable tumour appearing frequently in the testis despite tumour-free RPLNs. These findings support completion orchidectomy as part of advanced testicular germ cell treatment.
authors.affiliation: Department of Medical Oncology, Mount Vernon Cancer Centre, Middlesex, UK.
authors.forename: Rowan E
authors.initials: RE
authors.lastname: Miller
authors.forename: Tim
authors.initials: T
authors.lastname: Dudderidge
authors.forename: Robert
authors.initials: R
authors.lastname: Huddart
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Seckl
authors.forename: Gordon J S
authors.initials: GJ
authors.lastname: Rustin
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Christmas
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D018237:Germinoma / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents