Poster session 3: Andrology and Testicular tumors| Volume 8, ISSUE 8, P673, September 2009

C47 Salvage retroperitoneal lymphadenectomy after multiple chemotherapy regimens for nonseminomatous testicular tumors

      Introduction and Objectives

      We reviewed our experience with retroperitoneal lymphadenectomy (RPLA) after multiple cisplatin (CDDP)-based chemotherapy (CT) regimens in nonseminomatous testicular tumors (NSTT) patients (pts) and specifically evaluated clinic-pathologic and treatment trend in addition to potential predictors of survival.

      Material and Methods

      41 pts with NSTT underwent their RPLA between 1980 and 2005 after >2 regimens of CT. 13 pts (32%) necessitate redo-RPLA, combined with nephrectomy in pts. 13 extra-RP resections were performed in 11 pts (27%), including pulmonary (7), neck (4) and liver (2) sites.


      30 pts (73%) are rendered grossly free of disease (ds) and 26 (63%) obtained serologic remission. 9 pts who relapsed within MFI of 28 months (m) (RPLN 8, RPLN+lung 1) necessitated CT+surgery (3 teratoma, 6 vital GCT). 4/9 relapsing pts (44%) are currently free of ds with redo-RPLA. Alive, free of ds are 19 pts (46%) at MFU of 131 m. Study of RP pathology demonstrated the presence of fibrosis in 15%, teratoma in 39% and vital GCT in 46%, with survival in 67%, 56%, and 32%, respectively. Worse vs favourable histology occurred in relation of 32% vs 59% (p < 0.05). Different histology occurred in 38% at redo-RPLA and in 64% at ERP resection in comparison to previous RP pathology (p = 0.219). Univariate analysis of clinico-pathologic parameters associated with vital GCT at RPLA included RP mass >5 cm (p< 0.05), elevated AFP (p < 0.001) or HCG (p < 0.05) and ERP resection (p < 0.04). On univariate analysis survival was worse in pts with RP masses >5 cm (p< 0.04), elevated AFP (p < 0.05) or HCG (p < 0.007), ERP resection (p < 0.01), and vital GCT (p < 0.004). On multivariable analysis, a RP mass >5 cm (p< 0.03) and vital GCT (p < 0.005) predicted a worse prognosis. Vital GCT either in the RP or in ERP sites predicted worse prognosis (p = 0.001).


      Our data support the continued use of salvage RPLA in 3 separated groups of pts: 1. Pts who achieved a CR on 2nd line CT and have no radiologic evidence of ds should undergo RPLA; 2. Pts who achieved a PR to CT should undergo RPLA with ERP surgery, as indicated; 3. Highly selected pts with residual mass and elevated STM, particularly AFP, after CT may be candidates for surgery.