title: Is percent seminoma associated with intraoperative morbidity during post-chemotherapy RPLND?
abstract: BACKGROUND
  To evaluate whether varying degrees of seminomatous elements in the primary orchiectomy specimen would be predictive of patient morbidity during post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) since the desmoplastic reaction with seminoma is associated with increased intraoperative complexity.
  
  
  METHODS
  We retrospectively identified 127 patients who underwent PC-RPLND for residual retroperitoneal masses. Clinicodemographic, intraoperative, and 30 day postoperative outcomes were compared for patients with pure seminoma (SEM), mixed germ cell tumors (GCT) containing seminoma elements (NS+SEM), and tumors with no seminoma elements (NS). Multivariate logistic regression was used to determine independent predictors of intraoperative and postoperative 30 day complications.
  
  
  RESULTS
  We excluded 19 patients who received chemotherapy prior to orchiectomy, 2 patients with primary extragonadal GCT, and 3 patients who underwent re-do RPLND, leaving 103 patients for analysis. Fourteen patients (13.6%) had SEM, 18 (17.5%) had NS+SEM, and 71 (68.9%) had only NS elements. SEM patients were older (p = 0.03), had more intraoperative blood loss (p = 0.03), and were more likely to have residual seminomatous components in their post-chemotherapy lymph node (LN) histology (p = 0.01). Percent seminoma in the orchiectomy specimen was an independent predictor of estimated blood loss > 1.5 liters (odds ratio: 1.04, 95% confidence interval: 1.01-1.07; p = 0.013) after adjusting for age, stage, IGCCC risk category, preop chemotherapy, number and largest LN removed, need for vascular or adjacent organ resection (including nephrectomy), and LN histology.
  
  
  CONCLUSIONS
  Higher percentage of seminoma in the orchiectomy specimen is associated with increased estimated blood loss during PC-RPLND. Percent seminoma, therefore, may be a useful prognostic tool for appropriate pre-surgical planning prior to PC-RPLND.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Russell
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.forename: Gautum
authors.initials: G
authors.lastname: Agarwal
authors.forename: John S
authors.initials: JS
authors.lastname: Fisher
authors.forename: George J
authors.initials: GJ
authors.lastname: Richard
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.forename: Michael A
authors.initials: MA
authors.lastname: Poch
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D009017:Morbidity; D009919:Orchiectomy; D011379:Prognosis; D012187:Retroperitoneal Space / Q000473:pathology; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents