title: Post-chemotherapy retroperitoneal lymph node dissection in the management of metastatic testis cancer: the 16-year experience in an Irish setting.
abstract: BACKGROUND
  Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is an important tool in the management of advanced germ cell testis cancer, particularly non-seminoma.
  
  
  OBJECTIVE
  We present the 16-year experience with PC-RPLND in a single Irish tertiary referral centre, and compare our results to the major speciality centres worldwide.
  
  
  METHODS
  All 78 patients undergoing PC-RPLND for the treatment of metastatic testis cancer between January 1996 and December 2011 were included. Medical records were reviewed and up to date follow-up obtained from primary referral centres, patient's GPs and individual patient interview.
  
  
  RESULTS
  The mean age at diagnosis was 28.5 ± 7 years. Initial pathology included non-seminoma 62.8 %, seminoma 6.4 % and combined 19.2 %. All patients underwent pre-operative chemotherapy. The resection template utilised was bilateral infra-hilar in 29.5 %, unilateral infra-hilar in 46.2 % and supra-hilar in 20.5 %. Complete abdominal remission was achieved in all but one patient. Additional procedures were required in 38.5 % of patients (n = 30). Clavien Dindo grade three or four complications were seen in 8.9 %, including five patients who required early reoperation. Histology of RPLND specimen showed mature teratoma (41 %) and active cancer (11.5 %). Follow-up data were available for 66 patients (85 %). Median follow-up was 101 (11-207) months. Nine patients relapsed with median time to relapse 15 (8-60) months. Overall 5-year survival rate was 95.2 % (four deaths).
  
  
  CONCLUSIONS
  In this relatively small series due to small population and low disease incidence, we have shown acceptable peri-operative course, morbidity and oncological outcomes with PC-RPLND compared to major international centres.
authors.affiliation: Department of Urology, Tallaght Hosptial, Dublin 24, Ireland. s.w.considine@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Considine
authors.affiliation: Department of Urology, Tallaght Hosptial, Dublin 24, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Heaney
authors.affiliation: Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Conroy
authors.affiliation: Department of Urology, Tallaght Hosptial, Dublin 24, Ireland.
authors.forename: J A
authors.initials: JA
authors.lastname: Thornhill
mesh_terms: D000328:Adult; D019468:Disease Management; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D009919:Orchiectomy / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation / Q000401:mortality; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Nonseminomatous germ cell tumour; Oncology; Retroperitoneal lymph node dissection; Seminoma; Teratoma; Testicular cancer; Urology