Clinical Outcome of Post-Chemotherapy Retroperitoneal Lymph Node Dissection in Metastatic Nonseminomatous Germ Cell Tumour: A Systematic Review - Beyond the Abstract

Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is an essential part of the management of metastatic nonseminomatous testicular germ cell tumors. After treatment with chemotherapy, a substantial proportion of patients have a residual tumor in the retroperitoneum. These tumors contain teratoma in 30-40% of patients and vital cancer in 10-20% of patients. Therefore, resection of the residual mass is important to achieve curation.

Most studies on PC-RPLND are from high-volume institutions. It is debatable whether these reports reflect the outcome of PC-RPLND in general. After all, most patients are not treated in one of the leading centers in the world. In fact, multiple studies have shown the opposite: the majority of patients are treated in low-volume centers.

Our goal was to give an overview of the relapse rate of PC-RPLND in the literature. To do so, we performed a systematic search of the PubMed/MEDLINE and Embase databases. We identified 1,981 records and included 33 studies in the analysis after screening. These studies reported on 2,379 patients treated with open PC-RPLND and 463 patients with minimally-invasive PC-RPLND.

We found a weighted average relapse rate for open PC-RPLND of 11.4%. This was lower after unilateral dissection (6.3%), compared to bilateral dissection (14.6%). The average retroperitoneal relapse rate was 4.6%. Again, this was lower in series on unilateral dissection (3.1%), versus bilateral dissection (6.1%). For minimally-invasive PC-RPLND, the average relapse rate was 3.0% (unilateral: 2.1%; bilateral: 3.5%), with an average retroperitoneal relapse rate of 1.7%.

The relapse rate in our literature study is higher than what has been reported in publications from high-volume institutions. Multiple population-based studies have shown that the outcome of PC-RPLND is better in high-volume institutions. Therefore, the centralization of PC-RPLND is important.

The benefit of our study is that it gives the reader a more comprehensive overview of the relapse rate of PC-RPLND, compared to publications from high-volume institutions. However, there are many more institutions where this procedure is being performed, but their results have not (yet) been published.

Written by: Rianne Haarsma, Joost M Blok, Kim van Putten, Richard P Meijer

Dept. of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands., Dept. of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands; Dept. of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands., Dept. of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands.

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