Short and long-term outcomes of arterial and caval replacement during postchemotherapy retroperitoneal lymph node dissection in metastatic testicular cancer

IF 2.4 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2024-10-10 DOI:10.1016/j.urolonc.2024.09.022

Raymond A. Smith , Jacob D. McFadden , Andres Fajardo , Richard S. Foster , Timothy A. Masterson , Clint Cary

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Abstract

Background and objective

For patients with metastatic testicular cancer undergoing retroperitoneal lymph node dissection (RPLND), the burden of metastatic disease can require consideration for resection and replacement of major vessels despite chemotherapy. We aimed to clarify the outcomes for patients undergoing these major vascular procedures in a modern era.

Methods

Between 2000 and 2020, 2,054 patients with metastatic testicular cancer underwent a PC-RPLND; of those men, 41 also underwent an aortic, iliac, and/or inferior vena cava (IVC) resection. For men who required a vascular resection, clinicopathologic and operative details were collected. Kaplan–Meier curves were generated to estimate overall survival.

Results

The median preoperative mass size was 9cm in the retroperitoneum. Viable malignancy or teratoma was present in 85% of resected specimens. Following PC-RPLND and vascular resection, 22 (54%) patients recurred. The median (IQR) time to relapse was 4.6 (2.5–8.0) months. 18 (44%) patients died of disease. The overall complication rate was 56%. Ten (24%) patients had Clavien–Dindo III/IV complications, with 2 postoperative mortalities. The median overall survival was 14.9 months. Among the 41 patients, 18 patients had re-operative PC-RPLND and vascular resection; the re-operative PC-RPLND patients had significantly worse survival compared to initial attempt at PC-RPLND (9.3 vs. 162 months, P = 0.03).

Conclusions

The overall survival rate for patients undergoing PC-RPLND with resection of the aorta, IVC, and/or iliac artery is 45% at 2 years. For patients with limited treatment options, these complex surgeries may offer survival benefit with an acceptable morbidity profile.

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转移性睾丸癌化疗后腹膜后淋巴结清扫术中动脉和腔静脉置换的短期和长期疗效。

背景和目的：对于接受腹膜后淋巴结清扫术（RPLND）的转移性睾丸癌患者而言，尽管接受了化疗，但由于转移性疾病的负担，可能仍需考虑切除和更换主要血管。我们旨在明确在现代接受这些大血管手术的患者的治疗效果：2000年至2020年间，2054名转移性睾丸癌患者接受了PC-RPLND手术；其中41名男性患者还接受了主动脉、髂骨和/或下腔静脉（IVC）切除术。对于需要进行血管切除的男性，我们收集了他们的临床病理和手术细节。生成卡普兰-梅耶曲线以估算总生存率：结果：术前腹膜后肿块的中位尺寸为9厘米。85%的切除标本中存在存活的恶性肿瘤或畸胎瘤。PC-RPLND和血管切除术后，22例（54%）患者复发。复发的中位（IQR）时间为 4.6（2.5-8.0）个月。18（44%）名患者死于疾病。总体并发症发生率为 56%。10名（24%）患者出现了克拉维恩-丁多 III/IV 并发症，其中 2 人术后死亡。中位总生存期为 14.9 个月。在41名患者中，有18名患者再次接受了PC-RPLND手术和血管切除术；与初次尝试PC-RPLND手术的患者相比，再次接受PC-RPLND手术的患者生存期明显更短（9.3个月对162个月，P = 0.03）：结论：接受 PC-RPLND 并切除主动脉、IVC 和/或髂动脉的患者 2 年后的总生存率为 45%。对于治疗选择有限的患者来说，这些复杂的手术可能会在可接受的发病率情况下为患者带来生存益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.