title: Outcome of Resection and Chemotherapy versus Chemotherapy Alone for Retroperitoneal Recurrence of Testicular Cancer Involving the Inferior Vena Cava: A Retrospective Cohort Study of 22 Consecutive Patients.
abstract: OBJECTIVE
  Optimal treatment strategy for retroperitoneal recurrence of testicular cancer involving the inferior vena cava (IVC) is uncertain. The purpose of this study was to validate the hypothesis that surgical resection, en-bloc with the involved segment of IVC and its subsequent reconstruction followed by chemotherapy, would yield better oncologic results than chemotherapy alone.
  
  
  METHODS
  Two consecutive series of patients with retroperitoneal recurrence of testicular cancer involving the IVC, treated with surgical resection plus chemotherapy (group A, n=14) or chemotherapy alone (group B, n=8) were retrospectively reviewed. The mean duration of follow-up was was 65 months (range=8-184). Operative mortality and morbidity in group A, response to chemotherapy in group B, disease-specific survival and quality adjusted life-years (QALY) for both groups, were primary end-points of the study.
  
  
  RESULTS
  Postoperative mortality and morbidity (group A) were, respectively, nil and 14%. In group B, two patients (25%) fully responded to chemotherapy and remained free from disease progression. Disease-specific survival at 3 and 5 years was 81% and 54% in group A and 36% in group B both at 3 and 5 years, respectively (p=0.02). QALY was 3.92 in group A and 0.77 for both 3 and 5 years in group B, respectively, (p=0.031).
  
  
  CONCLUSIONS
  En bloc resection of retroperitoneal recurrence of testicular tumors invading the IVC, followed by chemotherapy, allows a better survival rate compared to chemotherapy alone.
authors.affiliation: The "F. Durante" Department of Surgery, University of Rome "La Sapienza", Rome, Italy giulio.illuminati@uniroma1.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Illuminati
authors.affiliation: Department of Surgery, Sant' Anna Hospital, Catanzaro, Italy.
authors.forename: Francesco G
authors.initials: FG
authors.lastname: Calio
authors.affiliation: The "F. Durante" Department of Surgery, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Angelici
authors.affiliation: The "F. Durante" Department of Surgery, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pizzardi
authors.affiliation: The "F. Durante" Department of Surgery, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Pasqua
authors.affiliation: The "F. Durante" Department of Surgery, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Masci
authors.affiliation: The "F. Durante" Department of Surgery, University of Rome "La Sapienza", Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vietri
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000556:secondary / Q000628:therapy*; D014682:Vena Cava, Inferior / Q000601:surgery
keywords: Testicular cancer; inferior vena cava; retroperitoneal recurrence