MP73-01 TEMPLATE VERSUS BILATERAL POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION IN PATIENTS WITH TESTICULAR CANCER

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer III (MP73)1 Apr 2019MP73-01 TEMPLATE VERSUS BILATERAL POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION IN PATIENTS WITH TESTICULAR CANCER Andreas Hiester*, Alessandro Nini, Anna Fingerhut, Robert große Siemer, Christian Winter, Peter Albers, and Achim Lusch Andreas Hiester*Andreas Hiester* More articles by this author , Alessandro NiniAlessandro Nini More articles by this author , Anna FingerhutAnna Fingerhut More articles by this author , Robert große SiemerRobert große Siemer More articles by this author , Christian WinterChristian Winter More articles by this author , Peter AlbersPeter Albers More articles by this author , and Achim LuschAchim Lusch More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557153.05812.65AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: This study aims to evaluate the oncological and functional outcome of bilateral versus unilateral template resection in patients with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for non-seminoma. METHODS: Between 2003 and 2018, 504 RPLNDs have been performed in 434 patients. The database of consecutive patients was queried to identify 171 patients with PC-RPLND after 1st line chemotherapy for a non-seminoma with or without bilateral template resection. Re-Do´s, late relapse, salvage patients and thoraco-abdominal approaches were excluded. Indication for a template resection was a unilateral residual mass mainly less than 5 cm as published (Heidenreich et al. 2009). Descriptive statistics were used to report preoperative features, post-operative outcomes and patterns of recurrence. Kaplan-Meier analyses were used to describe recurrence- and cancer specific mortality-free survival rates. RESULTS: 90 and 81 patients underwent unilateral and bilateral resection, respectively. Median size of residual mass was 7 cm for bilateral and 4 cm for unilateral template resection. Clinical stage II and III were present in 31% and 69% of patients, respectively. Median follow-up was 14.5 months (IQR 3.3 – 37.6). Recurrences were observed in 5 and 18 patients for the unilateral and bilateral approach, respectively. Only five recurrences occurred in the retroperitoneum, 3 in-field and 1 outside-field recurrence after a bilateral approach, and only one outside field in a template approach. The 1- and 2-year recurrence-free survival rates were 91% and 91%, 77% and 72% for patients treated with unilateral template and bilateral resection, respectively (p<0.0008). Median time to recurrence was 9.5 and 9 months in template and bilateral PC-RPLND group, respectively. As expected, adjunctive procedures were performed in 56 patients (33%) and were significantly more frequent in bilateral PC-RPLND group (44% vs. 22%, p<0.002). High-grade complication rate (Clavien-Dindo ≥ III) was 3% and 9% in unilateral template and bilateral PC-RPLND group, respectively (p=0.2). In 87% and 44% nerve-sparing was achieved in unilateral and bilateral approaches, respectively. In patients with complete follow-up data, the preservation rate of antegrade ejaculation was significantly higher in the unilateral group. CONCLUSIONS: Unilateral template PC-RPLND in the 1st line setting is oncologically safe when the residual mass is < 5 cm. Nerve-sparing and preservation of antegrade ejaculation with a unilateral resection is significantly better. Source of Funding: none Düsseldorf, Germany© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1064-e1064 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreas Hiester* More articles by this author Alessandro Nini More articles by this author Anna Fingerhut More articles by this author Robert große Siemer More articles by this author Christian Winter More articles by this author Peter Albers More articles by this author Achim Lusch More articles by this author Expand All Advertisement PDF downloadLoading ...