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Repeat retroperitoneal lymph node dissection for metastatic testicular cancer

Heidenreich A et al. (2005) Repeat retroperitoneal lymphadenectomy in advanced testicular cancer. Eur Urol 47: 64–71

Patients with advanced testicular cancer occasionally require repeat retroperitoneal lymph node dissection (RPLND) due to incomplete resection or recurrence of retroperitoneal masses. Heidenreich et al. have carried out a retrospective analysis of patients undergoing repeat RPLND at their center.

A total of 18 patients with metastatic testicular cancer underwent primary nerve-sparing RPLND (n = 4) or residual tumor resection (n = 14). All had recurrent or residual retroperitoneal masses (median diameter 7.8 cm) and were referred for repeat RPLND. The majority of the recurrences were at the site of the initial retroperitoneal tumor, indicating that primary surgery had been inadequate. Histological examination identified mature teratoma or viable cancer in 10 patients, all of whom received additional chemotherapy. The resected specimens of the remaining eight patients indicated necrosis/fibrosis. The overall disease-specific survival rates after a mean follow-up of 22 months were 85%, 50% and 100% for patients with mature teratoma, viable cancer or necrosis, respectively.

Heidenreich et al. note that repeat RPLND is technically demanding and so requires thorough preoperative work-up and extensive, interdisciplinary clinical experience. Resection of adjacent organs or vascular structures, for example, is necessary in as many as half of repeat RPLND cases. The authors conclude that the procedure should be carried out only at centers of expertise, where its safety and efficacy can be maximized.

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Repeat retroperitoneal lymph node dissection for metastatic testicular cancer. Nat Rev Urol 2, 64 (2005).

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