Adjunctive nephrectomy at post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer Journal Article
| Authors: | Stephenson, A. J.; Tal, R.; Sheinfeld, J. |
| Article Title: | Adjunctive nephrectomy at post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous germ cell testicular cancer |
| Abstract: | Purpose: Patients with metastatic testicular cancer with residual masses encasing the renal hilum or kidney after platin based chemotherapy may require adjunctive nephrectomy to achieve complete resection at post-chemotherapy retroperitoneal lymph node dissection. We reviewed our experience with adjunctive nephrectomy to assess the impact on cancer control and renal function. Materials and Methods: Of 647 post-chemotherapy retroperitoneal lymph node dissection procedures performed at our institution since 1989 adjunctive nephrectomy has been performed in 32 patients (5%). Patient information was obtained from a prospective database. Median followup was 31 months. Results: Of the adjunctive nephrectomy procedures 17 (53%) were performed in high risk settings such as post-salvage chemotherapy, desperation retroperitoneal lymph node dissection, late relapse and reoperative retroperitoneal lymph node dissection. Disease was present in the adjunctive nephrectomy specimen in 21 patients (66%). Following post-chemotherapy retroperitoneal lymph node dissection 7 patients had disease relapse and 5-year disease-free survival was 66%. No case of relapse required substitution for cisplatin due to compromised renal function. Progression to chronic renal insufficiency occurred in 3 patients, 1 of whom required hemodialysis. The calculated creatinine clearance after adjunctive nephrectomy was more than 30% below the age specific norm in 14 patients (50%) and median patient age was 40 years. Conclusions: Adjunctive nephrectomy at post-chemotherapy retroperitoneal lymph node dissection is most frequently performed in patients with high risk features to ensure the completeness of resection. When indicated, adjunctive nephrectomy should be performed because residual cancer is frequently present and long-term cancer control can be achieved in 66% of patients. Although adjunctive nephrectomy did not interfere with subsequent chemotherapy, the renal reserve in these patients was substantially reduced in 50%, emphasizing the importance of preventative measures to preserve long-term renal function. © 2006 American Urological Association. |
| Keywords: | adolescent; adult; cancer chemotherapy; cancer survival; controlled study; aged; middle aged; major clinical study; salvage therapy; cisplatin; disease free survival; combined modality therapy; follow up; lymph node dissection; lymph node excision; creatinine; kidney failure; nephrectomy; survival time; testicular neoplasms; cancer relapse; neoplasms, germ cell and embryonal; retroperitoneal neoplasms; age distribution; testis cancer; germ cell tumor; chronic kidney failure; creatinine clearance; retroperitoneal space; nonseminomatous germ cell testicular cancer |
| Journal Title: | Journal of Urology |
| Volume: | 176 |
| Issue: | 5 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2006-11-01 |
| Start Page: | 1996 |
| End Page: | 1999 |
| Language: | English |
| DOI: | 10.1016/j.juro.2006.07.050 |
| PUBMED: | 17070234 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 12" - "Export Date: 4 June 2012" - "CODEN: JOURA" - "Source: Scopus" |
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255Sheinfeld -
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Tal
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