Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital. / La densidad de los ganglios linfáticos en la linfadenectomía retroperitoneal como marcador novel para predecir la recurrencia en pacientes con cáncer testicular de células germinales: estudio de casos y controles y experiencia clínica a largo plazo de un hospital de referencia terciario.

INTRODUCTION AND OBJECTIVES: In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC). MATERIALS AND METHODS: The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease. RESULTS: The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r= -0.490, P=.024 and r= -0.450, P=.041, respectively). CONCLUSIONS: There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

Pelvic lymph node dissection in prostate cancer: Laparoscopy is not dead. / Disección de los ganglios linfáticos pélvicos en el cáncer de próstata: la laparoscopia no ha muerto.

CONTEXT: Pelvic lymph node dissection (PLND) in localized prostate cancer is feasible through an open, laparoscopic or robot-assisted approach. Data comparing the three approaches is sparse. OBJECTIVE: To perform a review in order to compare the effectiveness of the different PLND approaches. ACQUISITION OF EVIDENCE: A search was performed including the following words: ("pelvic lymph node dissection") OR ("pelvic lymphadenectomy") AND ("French"[Language] OR "English"[Language]) AND ("1990"[Date-Publication]: "3000"[Date-Publication]) AND prostatectomy[Title]). Twenty-nine articles were finally included in the qualitative synthesis. EVIDENCE SYNTHESIS: Laparoscopic pelvic lymph node dissection in prostate cancer is a minimally invasive procedure with a relatively short operative time, minimal blood loss, lower level of pain, shorter hospital stay, and fewer perioperative complications when compared to an open approach. This technique is more cost-effective than a robot-assisted approach. CONCLUSION: Concerning the treatment of localized prostate cancer, laparoscopic pelvic lymph node dissection should be learned and applied by urologists.

Factores asociados a la histología de masa residual retroperitoneal post quimioterapia en tumor testicular de células germinales / Factors Associated with the Histology of Retroperitoneal Residual Mass Post Chemotherapy in Testicular Germ Cell Tumo

Objetivo El objetivo de este estudio es describir las características y factores relacionados con la histología de la masa residual postquimioterapia en pacientes con tumor de células germinales de origen testicular sometidos a linfadenectomía retroperitoneal durante 12 años de seguimiento. Métodos Retrospectivamente se recolectaron datos clínicos, quirúrgicos y patológicos de la historia clínica de los pacientes en un centro de referencia de manejo de cáncer durante un periodo de 12 años. Se estimó la asociación entre los datos recolectados con la histología del tumor residual post quimioterapia. Resultados Se incluyeron 64 pacientes, la edad promedio fue 28.1 años, el tamaño promedio de masa residual fue de 6.7 cm. La histología de la masa residual fue teratoma en 60.9%, necrosis 26.5% y tumor viable 12.5%. El grupo pronóstico tiene asociación con la histología de la masa retroperitoneal. Las masas con histología de necrosis tuvieron menor tamaño con media 6.5 cm mientras que otras histologías tuvieron tamaño promedio de la masa residual de 10.4 cm. Conclusiones La LNDRP-PC es el estándar de tratamiento en masas residuales retroperitoneales después de quimioterapia y puede generar sobre-tratamiento hasta en 50% de los casos. El teratoma en la histología testicular está relacionado mayor tamaño de la masa residual retroperitoneal. Las características histológicas de la masa residual son comparables con otras series.

Objective The aim of the study is to describe factors and characteristics related with the post-chemotherapy residual mass histology in patients who undergoing RPLND. Methods Clinical, surgical and pathological data were retrospectively recorded from medical records of patients with diagnosis of germ cell tumor and post-chemotherapy residual retroperitoneal tumor in a cancer referral center over a period of 12 years. The association between the data collected and the post-chemotherapy residual tumor histology was assessed. Results Sixty-four patients were included with average age of 28.1 years. The mean residual mass size was 6.7 cm. The histology of the mass was teratoma in 60.9%, necrosis 26.5% and viable tumor 12.5%. Prognostic group was associated with the mass histology. Mass with necrosis histology was smaller with mean size of 6.5 cm, while other histologies had an average mass size of 10.4 cm. Conclusion PC-RPLND is the standard of management of retroperitoneal residual mass after chemotherapy and could over treat in up to 50% of cases. Teratoma component in testicular histology is related to increase size of the residual mass. Histology findings of the retroperitoneal mass are comparable with other series.

Undetectable PSA after radical prostatectomy is more likely in low burden N+ prostate cancer patients when an extended lymph node dissection is performed. / Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada.

OBJECTIVES: To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients. MATERIALS AND METHODS: The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test. RESULTS: 1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3rd month was higher in patients who received an ePLND (HR=5.18; IC 95%=1.16-23.11; P=.03). CONCLUSIONS: ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics.

Number of metastatic lymph nodes as determinant of outcome after salvage radical prostatectomy for radiation-recurrent prostate cancer. / Número de ganglios linfáticos metastásicos como determinante de los resultados de la prostatectomía radical de rescate en el cáncer de próstata de recidivante tras radioterapia.

BACKGROUND: Presence of lymph node metástasis (LNM) at salvage radical prostatectomy (sRP) is associated with poor outcome. Predictors of outcome in this context remain undetermined. ThE objective was to assess the role of number of positive lymph node on outcome of patients with LNM after sRP and for radio-recurrent prostate cancer. MATERIAL AND METHODS: We analyzed data from a consecutive cohort of 215 men treated with sRP at a single institution. We used univariate Cox proportional hazard regression models for biochemical recurrence (BCR) and metastatic outcomes, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesicle invasion, time between radiation therapy and sRP, and number of positive nodes as predictors. RESULTS: Of the 47 patients with LNM, 37 developed BCR, 11 developed distant metastasis and 4 died with a median follow-up of 2.3 years for survivors. The risk of metastases increased with higher pre-operative PSA levels (HR 1.19 per 1ng/ml; 95% CI: 1.06-1.34; P=.003). The remaining predictors did not reach conventional levels of significance. However, removal of 3 or more positive lymph nodes demonstrated a positive association, as expected, with metastatic disease (HR 3.44; 95% CI: 0.91-13.05; P=.069) compared to one or 2 positive nodes. Similarly, the presence of extraprostatic extension, seminal vesicle invasion and Gleason grade greater than 7 also demonstrated a positive association with higher risk of metástasis, with hazard ratios of 3.97 (95% CI: 0.50, 31.4; P=.2), 3.72 (95% CI: 0.80-17.26; P=.1), and 1.45 (95% CI: 0.44-4.76; P=.5), respectively. CONCLUSIONS: In patients with LNM after sRP for radio-recurrent prostate cancer, the risk of distant metástasis is likely to be influenced by the number of positive nodes (3 or more), high preoperative PSA, Gleason grade and advanced pathologic stage. These results are consistent with the findings of number of nodes (1 to 2 vs. 3 or more nodes positive) as a prognostic indicator after primary radical prostatectomy and strengthen the plea for a revision of the nodal staging for prostate cancer.

Resección arterial de grandes vasos debido a tumor germinal residual retroperitoneal: Tres casos / Arterial resection of large vessels due to a residual germinal retroperitoneal tumor: Three cases

Objetivo: Demostrar la factibilidad, morbilidad y beneficio terapéutico de la resección de tumor residual en los grandes vasos. Sede: Instituto Nacional de Cancerología México. Diseño: Reporte de casos Métodos: Se revisaron expedientes de 2004 al 2008, encontrando 58 pacientes susceptibles de linfadenectomía retroperitoneal posterior a tratamiento con quimioterapia por tumores germinales no seminomatosos. Tres pacientes fueron candidatos a resección y reconstrucción de grandes vasos mediante una prótesis de politetrafluoretileno (PTFE). Resultados: La edad media fue de 28.5 años al momento del diagnóstico. La media del tumor fue de 5.75 cm. El sangrado promedio transoperatorio fue de 500 ml. El seguimiento fue de 27 meses posterior al remplazo vascular. Un paciente murió a los 3 días de postoperatorio por insuficiencia renal. Conclusión: El remplazo aórtico en tumores residuales retroperitoneales posterior a quimioterapia, debe ser realizado en casos seleccionados con el fin de obtener un beneficio real en supervivencia, siendo factible de realizar con poca morbimortalidad en centros especializados.

Objective: To demonstrate the feasibility, morbidity, and therapeutic benefit of the resection of large vessels' residual tumor. Setting: National Institute of Cancerology, Mexico. Design: Case report. Methods: We reviewed case histories from 2004 to 2008 during which 58 patients were susceptible to retroperitoneal lymphadenectomy after treatment with chemotherapy due to germinal non-seminomatous tumors. Three patients were candidates for resection and reconstruction of large vessels by means of a polytetrafluorethylene (PTFE) prosthesis. Results: Mean age was of 28.5 years at the time of diagnosis. The mean average size of the tumor was of 5.75 cm. Average transoperative bleeding amounted to 500 ml. Follow-up was of 27 months after the vascular replacement. One patient died 3 days after surgery due to renal failure. Conclusion: Aortic replacement in retroperitoneal tumors after chemotherapy should be performed in selected cases to obtain an actual benefit in survival, and it is possible to perform with low morbidity and mortality in specialized medical centers.