Postchemotherapy Retroperitoneal Lumpectomy in Patients with Nonseminoma Testicular Cancer: A Nationwide Study

Josephine Julie Rosenvilde*, Jakob Lauritsen, Mikkel Bandak, Thomas Wagner, Mads Agerbæk, Lars Dysager, Mikael Aagaard, Gedske Daugaard

*Corresponding author for this work

Abstract

BACKGROUND AND OBJECTIVE: Optimal treatment outcomes in patients with metastatic nonseminoma testicular cancer are achieved with chemotherapy and subsequent surgery in cases with residual tumor. In Denmark, postchemotherapy retroperitoneal lumpectomy (RPLP) is performed in patients with residual tumors >1 cm. There is a need to clarify whether this surgical method provides acceptable treatment results. Our objective was to describe morbidity and oncological outcomes of postchemotherapy RPLP.

METHODS: This was a retrospective population-based multicenter study including patients with nonseminoma testicular cancer and postchemotherapy RPLP performed in Denmark between 1990 and 2015. A total of 219 patients were eligible, with median follow-up of 19 yr. Postoperative complications were evaluated according to the Clavien-Dindo classification. The cumulative incidence of recurrence inside or outside the borders of a bilateral surgical template, progression-free survival (PFS), and overall survival estimates were calculated using the Kaplan-Meier method.

KEY FINDINGS AND LIMITATIONS: After median follow-up of 19 yr, 31/219 patients (14%) experienced a surgical complication, of which 5% were Clavien-Dindo grade ≥III. In total, 37 patients experienced a recurrence. The 5-yr, 10-yr, and 20-yr cumulative risk of recurrence inside a bilateral template was 4.3%, 5.9%, and 5.9%, respectively. The 10-yr PFS rate was 83% and the 10-yr overall survival rate was 96%. The main limitation of the study is the retrospective design.

CONCLUSIONS AND CLINICAL IMPLICATIONS: With few patients experiencing a major postoperative complication and a 10-yr cumulative rate of 5.9% for recurrence inside a bilateral surgical template, postchemotherapy RPLP appears to be a safe alternative to template surgery for disseminated nonseminoma.

PATIENT SUMMARY: We looked at minimal surgery to remove tumor tissue remaining after chemotherapy in patients with testicular cancer. We found a low frequency of complications, tumor recurrence, and death.

Original languageEnglish
JournalEuropean urology oncology
Volume7
Issue number3
Pages (from-to)589-596
Number of pages8
ISSN2588-9311
DOIs
Publication statusPublished - 2024

Keywords

  • Adult
  • Combined Modality Therapy
  • Denmark/epidemiology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local/epidemiology
  • Neoplasms, Germ Cell and Embryonal/surgery
  • Postoperative Complications/epidemiology
  • Retroperitoneal Space
  • Retrospective Studies
  • Testicular Neoplasms/surgery
  • Treatment Outcome
  • Young Adult

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