[Reduced retroperitoneal lymphadenectomy for clinical stage I non seminomatous germ cell testicular cancer]. / Linfadenectomia retroperitoneal reducida en cancer testicular de celulas germinales no seminomatoso estadio clinico I.

OBJECTIVES: The best treatment of clinical stage I non-seminomatous germ cell testicular cancer (NSGCTC) is controversial. Lymphadenectomy allows an adequate retroperitoneal staging and cures up to 70% of patients in pathological stage II. The objective of this study is to analyse our experience in the treatment of this patients with radical orchiectomy and reduced retroperitoneal lymphadenectomy (RRL) as the initial treatment. METHODS: Retrospective study of patients with clinical stage I NSGCTC submitted to radical orchiectomy and RRL at the Urology Service of the University of Chile Clinical Hospital, from January 1990 to December 2000. INCLUSION CRITERIA: retroperitoneal staging with computed tomography (CT), normal tumor markers after orchiectomy and testicular and retroperitoneal biopsy informed at our hospital. The following metastatic risk factors in the testicular biopsy were checked: vascular invasion (venous and/or lymphatic), infiltration of tunica albuginea, rete testis, epididymis, and spermatic cord. RESULTS: 36 patients with 37 testicular tumors were analysed (1 bilateral case). Average age 28 years old. Twenty nine mixed tumors (78%); most frequent histology embryonal carcinoma (76%). Average surgery time 2 hr 7 min; average dissected lymph nodes 13. Introoperative complications: 2,8%; postoperative complications: a) early 5,6%; b) late: 5,6%. No mortality, no second surgeries nor blood transfusions. Four cases of positive RRL (11%). Only retroperitoneal relapses in 2 cases (8%), one out of the limits of dissection. Chemotherapy in 7 patients (19%) a total of 18 cycles. Four cases of contralateral tumor during follow-up (11%). Hundred percent survival at 76 months (16-160). We described sensibility, specificity, positive and negative predictive value of metastatic risk factors. Only epididymis infiltration was a significant predictor of metastasis (p=0,04). CONCLUSIONS: In our hands RRL is a safe surgery, with 5,6% mayor complications. The low false negative rate of CT in staging (11%) and the high number of retroperitoneal relapses (8%) in our study contrast with those of other publications. Limited by the size of our study group, the epididymis infiltration was the only statistically significant predictor of metastasis. Clinical stage I NSGCTC initially managed with RRL has a 100% survival.

Linfadenectomia retroperitoneal reducida en cáncer testicular de células germinales no seminomatoso estadio clinico I / Reduced retroperitoneal lymphadenectomy for clinical stage I non seminomatous germ cell testicular cancer

Objetivo: Existe controversia sobre el tratamiento óptimo de los cánceres testiculares de células germinales no seminomatosos (CTCGNS) estadio clínico I. La linfadenectomía permite una adecuada estadificación retroperitoneal y cura hasta el 70% de los pacientes en estadio II patológica. El objetivo de este estudio es analizar nuestra experiencia en el tratamiento de estos pacientes mediante orquiectomía radical y linfadenectomía retroperitoneal reducida (LRR) como tratamiento inicial. Método: Estudio retrospectivo de pacientes con CTCGNS estadio clínico I sometidos a orquiectomía radical y LRR en el Servicio de Urología del Hospital Clínico Universidad de Chile entre Enero de 1990 y Diciembre de 2000. Criterios de inclusión: estadificación retroperitoneal con tomografía computada (TC), marcadores tumorales normales después de la orquiectomía y biopsia testicular y retroperitoneal informada en nuestro hospital. Se revisaron los siguientes factores de riesgo de metástasis: invasión vascular (venosa y/o linfática), infiltración de túnica albugínea, rete testis, epidídimo y cordón espermático. Resultados: Se analizan 36 pacientes con 37 tumores testiculares (1 caso bilateral). Edad promedio 28 años. Veinte y nueve tumores mixtos (78%); histología mas frecuente carcinoma embrionario (76%). Tiempo promedio de la cirugía 2 horas y 7 minuntos ; promedio de ganglios resecados 13. Complicaciones intraoperatorias 2,8%; complicaciones postoperatorias: a) tempranas 5,6%, b) tardías 5,6%. Sin mortalidad, sin reoperaciones ni transfusiones sanguíneas. Cuatro casos de LRR positivas (11%). Sólo recaídas retroperitoneales en 2 casos (8%), una fuera de los límites de disección. Quimioterapia en 7 pacientes (19%), un total de 18 ciclos. Cuatro casos de tumor testicular contralateral durante el seguimiento (11%). Cien por ciento de sobrevida a 76 meses (16-160). Describimos sensibilidad, especificidad y valor predictivo positivo y negativo de los factores de riesgo de metástasis. Sólo la infiltración de epidídimo fue predictor de metástasis (p=0,04). Conclusión: En nuestras manos la LRR es una cirugía segura que presenta complicaciones mayores en el 5,6% de los casos. El bajo porcentaje de falsos negativos de la TC en la estadificación y la alta tasa de recaída retroperitoneal contrasta con los datos de otras publicaciones. La infiltración de epidídimo fue el único predictor de metástasis estadísticamente significativo, lo cual se encuentra limitado por el tamaño del grupo estudiado. Los CTCGNS etapa clínica I tratados inicialmente con LRR tienen un 100% de sobrevida (AU)

Objectives: The best treatment of clinical stage I non-seminomatous germ cell testicular cancer (NSGCTC) is controversial. Lymphadenectomy allows an adequate retroperitoneal staging and cures up to 70% of patients in pathological stage II. The objective of this study is to analyse our experience in the treatment of this patients with radical orchiectomy and reduced retroperitoneal lymphadenectomy (RRL) as the initial treatment. Methods: Retrospective study of patients with clinical stage I NSGCTC submitted to radical orchiectomy and RRL at the Urology Service of the University of Chile Clinical Hospital, from January 1990 to December 2000. Inclusion criteria: retroperitoneal staging with computed tomography (CT), normal tumor markers after orchiectomy and testicular and retroperitoneal biopsy informed at our hospital. The following metastatic risk factors in the testicular biopsy were checked: vascular invasion (venous and/or lymphatic), infiltration of tunica albuginea, rete testis, epididymis, and spermatic cord. Results: 36 patients with 37 testicular tumors were analysed (1 bilateral case). Average age 28 years old. Twenty nine mixed tumors (78%); most frequent histology embryonal carcinoma (76%). Average surgery time 2hr 7min; average dissected lymph nodes 13. Intraoperative complications: 2,8%; postoperative complications: a) early 5,6%; b) late: 5,6%. No mortality, no second surgeries nor blood transfusions. Four cases of positive RRL (11%). Only retroperitoneal relapses in 2 cases (8%), one out of the limits of dissection. Chemotherapy in 7 patients (19%) a total of 18 cycles. Four cases of contralateral tumor during follow-up (11%). Hundred percent survival at 76 months (16-160). We described sensibility, specificity, positive and negative predictive value of metastatic risk factors. Only epididymis infiltration was a significant predictor of metastasis (p=0,04). Conclusions: In our hands RRL is a safe surgery, with 5,6% mayor complications. The low false negative rate of CT in staging (11%) and the high number of retroperitoneal relapses (8%) in our study contrast with those of other publications. Limited by the size of our study group, the epididymis infiltration was the only statistically significant predictor of metastasis. Clinical stage I NSGCTC initially managed with RRL has a 100% survival (AU)