Post-chemotherapy retroperitoneal lymph node dissection following first-line treatment in patients with advanced pure seminoma of the testis.
Abstract
Purpose
To report oncological, functional outcomes and surgery-associated complications for post-chemotherapeutic retroperitoneal lymphadenectomy (PC-RPLND) after first-line chemotherapy in patients with pure metastatic seminoma. MATERIAL AND
Methods
Retrospective international, multi-institutional study of PC-RPLND in pure seminomas and residual masses following 3-4 cycles PEB, TIP or PEI between 2000 and 2023. Patients underwent PC-RPLND for marker negative, FDG-PET/CT positive residual masses > 3cm or marker negative retroperitoneal progression. Primary goal of the study was the evaluation progression-free survival (PFS) following surgery. Secondary goals were cancer-specific survival and overall survival (OS), surgery-associated complications (Clavien-Dindo classification).
Results
The median (IQR) follow-up is 56 (2 - 164) months. 108 patients with a median (IQR) age of 40 (31 - 68) years were included. 93% of PC-RPLNDs were performed via an open approach. Adjunctive surgery was performed in 46 (43%) patients. 30-day perioperative Clavien - Dindo complications ≥ 3a developed in 11 (10.1%). Final pathology revealed necrosis/fibrosis in 65 (60.2%), seminoma in 41 (38%), nonseminoma in 2 (1.8%). FDG-PET/CT had a positive and negative predictive value of 55.9% and 84.6%, respectively. On multivariate logistic regression, marker-negative progression was significantly inversely associated with PFS (p<0.001). 29 (27%) patients relapsed, and 7 (6.5%) patients died of disease. 5-year PFS survival after surgery alone for viable seminoma was 44%; 2-year and 5-year OS for viable seminoma was 88% and 84%, resp.
Conclusions
In selected cases with metastatic seminoma and progressive retroperitoneal masses following first-line chemotherapy, PC-RPLND may be a valuable option if masses can be resected completely without the necessity to resect of adjacent organs. In all other cases, high-dose chemotherapy remains the best option.