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Primary retroperitoneal lymph node dissection as treatment for low-volume metastatic seminoma in a population-based cohort: the Swedish Norwegian testicular cancer group experience
Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Department of Urology, Haukeland University Hospital, Bergen, Norway.
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2024 (Engelska)Ingår i: European Urology Open Science, ISSN 2666-1691, E-ISSN 2666-1683, Vol. 65, s. 13-19Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and objective: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy.

Methods: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).

Key findings and limitations: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13–24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16–30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4–14). PFS was 90% (95% confidence interval: 0.86–1) and OS was 100% at 24 mo.

Conclusions and clinical implications: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.

Patient summary: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.

Ort, förlag, år, upplaga, sidor
Elsevier, 2024. Vol. 65, s. 13-19
Nyckelord [en]
Germ cell cancer, Metastatic, Retroperitoneal, Retroperitoneal lymph node dissection, Robotic surgery, Seminoma, Testicular
Nationell ämneskategori
Kirurgi Urologi och njurmedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-226955DOI: 10.1016/j.euros.2024.05.006Scopus ID: 2-s2.0-85195585539OAI: oai:DiVA.org:umu-226955DiVA, id: diva2:1876723
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CancerfondenTillgänglig från: 2024-06-25 Skapad: 2024-06-25 Senast uppdaterad: 2024-06-25Bibliografiskt granskad

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