ORLANDO, FL USA (UroToday.com) - Two abstracts highlighted the surgical approach and surgical and pathological outcomes for resection of retrocrural masses in patients with metastatic germ cell tumor. Dr. Hristos Kaimakliotis presented the Indiana University series first. Their series included 211 patients, the overwhelming majority included teratoma at pathological diagnosis. Dr. Kaimakliotis highlighted surgical outcomes by reviewing intraoperative and postoperative complications as well as length of stay and requirement for multiple procedures. As might be expected, chyle leak was the most common complication, but there were also a small number of pancreatic fistulae and spinal cord ischemia/paraplegia, presumably from division of lumbar vessels. He then showed how the incision and approach has evolved over time towards an intraabdominal/ transdiaphragmatic approach. This allows for a single procedure rather than staged procedures.
Dr. Itay Sternberg reviewed the MSKCC series of 37 patients (Retrocrural dissection during retroperitoneal lymph node dissection for testicular cancer). This cohort was dichotomized by indication (post-chemotherapy vs salvage). Again most patients had teratoma in the surgical specimen, regardless of indication. Six patients in this series required nephrectomy (all left sided). Short-term survival data was available as well (median 2.8 years) with death of 10 patients, all cancer-specific mortalities. The MSKCC approach was a midline abdominal incision with transdiaphragmatic resection in all patients.
Overall both centers believe that this is a technically challenging surgery and should be performed by experienced personnel in conjunction with a thoracic surgeon.
Presented by Hristos Kaimakliotis at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
San Diego, CA USA
Written by Phillip Abbosh, MD, PhD, medical writer for UroToday.com