Ladislav Valanský, Richard Bartl, Tibor Packaň, Miroslav Iláš, Igor Andrašina
Objective: To evaluate the results of retroperitoneal lymphadenectomy (RPLA) of residual mass persisting after primary chemotherapy (CHT) in patients with advanced non-seminomatous germ cell testicle tumors (NSGCT). Material and Methods: In the period of 1989 - 2006, 22 patients aged 16 - 34 years (mean 24.5 years) at the time of orchiectomy were treated in our departments, 7 with right sided and 15 with left sided tumour. Based on clinical findings, markers values and CT scans 13 = 59 % patients were classified as clinical stage II B/C and 9 = 41 % stage III B/C. In three patients retroperitoneal metastases developed 3, 12 and 16 years after CHT, respectively. Three patients underwent supraclavicular lymphadenectomy for metastases prior to CHT. All patients but one had reference values of markers prior to RPLA. RPLA was limited to residual mass only including minimally enlarged lymph nodes undetected by CT scan. Because of residual mass splenectomy was performed in one patient at the time of RPLA. Mediastinal, lung and/or liver metastases were qualified as unsuitable for resection in six patients. Additional RPLA in three patients was indicated in all cases for recurrence outside the region of first resection (suprahilar 1, iliac 2). Results: Teratoma components in testicular tumour were found in 16 = 72.7 % patients. Viable cancer, mature teratoma and necrosis and/or reparative changes were found in residual mass in 13.6 %, 50 % and 36.4 %, respectively. With a mean of 100 (5 - 205) months follow-up period 16 = 72.7 % patients are alive including two (9.1 %) patients with residual disease. 6 = 27.3 % patients died 6 - 150 months (mean 62 months) after RPLA because of disease progression despite postoperative salvage CHT. All patients had organ and/or mediastinal metastases unsuitable for resection and teratoma component in primary tumour. The only serious postoperative complication observed was prolonged lymphatic leakage in 3 = 13.6 % patients. Conclusions: Prognosis of NSGCT in clinical stage II B/C treated by primary chemotherapy followed by RPLA in case of residual mass as a rule is good. With NSGCT in clinical stage III B/C the prognosis is much more unfavourable, especially in case of non resectable organ or mediastinal metastases and the presence of teratoma components in primary tumour and/or residuals.