TY  - EJOU
AU  - Russell, Christopher M. 
AU  - Sharma, Pranav 
AU  - Agarwal, Gautum 
AU  - Fisher, John S. 
AU  - Richard, George J. 
AU  - Spiess, Philippe E. 
AU  - Pow-Sang, Julio M. 
AU  - Poch, Michael A. 
AU  - Sexton, Wade J. 

TI  - Is percent seminoma associated with intraoperative morbidity during post-chemotherapy RPLND?
T2  - Canadian Journal of Urology

PY  - 2016
VL  - 23
IS  - 1
SN  - 1488-5581

AB  - <b>Introduction:</b> To evaluate whether varying degrees of seminomatous elements in the primary orchiectomy specimen would be predictive of patient morbidity during post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) since the desmoplastic reaction with seminoma is associated with increased intraoperative complexity.<br/>

<b>Materials and methods:</b> We retrospectively identified 127 patients who underwent PC-RPLND for residual retroperitoneal masses. Clinicodemographic, intraoperative, and 30 day postoperative outcomes were compared for patients with pure seminoma (SEM), mixed germ cell tumors (GCT) containing seminoma elements (NS+SEM), and tumors with no seminoma elements (NS). Multivariate logistic regression was used to determine independent predictors of intraoperative and postoperative 30 day complications.<br/>

<b>Results:</b> We excluded 19 patients who received chemotherapy prior to orchiectomy, 2 patients with primary extragonadal GCT, and 3 patients who underwent re-do RPLND, leaving 103 patients for analysis. Fourteen patients (13.6%) had SEM, 18 (17.5%) had NS+SEM, and 71 (68.9%) had only NS elements. SEM patients were older (p = 0.03), had more intraoperative blood loss (p = 0.03), and were more likely to have residual seminomatous components in their post-chemotherapy lymph node (LN) histology (p = 0.01). Percent seminoma in the orchiectomy specimen was an independent predictor of estimated blood loss > 1.5 liters (odds ratio: 1.04, 95% confidence interval: 1.01-1.07; p = 0.013) after adjusting for age, stage, IGCCC risk category, preop chemotherapy, number and largest LN removed, need for vascular or adjacent organ resection (including nephrectomy), and LN histology.<br/>

<b>Conclusions:</b> Higher percentage of seminoma in the orchiectomy specimen is associated with increased estimated blood loss during PC-RPLND. Percent seminoma, therefore, may be a useful prognostic tool for appropriate pre-surgical planning prior to PC-RPLND.
KW  - testicular cancer
KW  -  germ cell tumor
KW  -  seminoma
KW  -  orchiectomy
KW  -  retroperitoneal lymph node  dissection
KW  -  post-chemotherapy
KW  -  blood loss

DO  -