Retroperitoneal vascular surgery for the treatment of giant growing teratoma syndrome.

Abstract

OBJECTIVE:

To evaluate whether an aggressive surgical policy, which included vascular surgery with standard retroperitoneal lymph node dissection (RPLND), would be justified for managing bulky retroperitoneal growing teratoma syndrome (GTS).

METHODS:

Data were collected retrospectively from a series of 12 patients who, from 1992 to 2010, underwent radical RPLND for bulky GTS (retroperitoneal mass≥10 cm in diameter). For complete resection, vascular procedures and nephrectomy were performed.

RESULTS:

Median tumor diameter was 100 mm before and 140 mm (range 100-300) after chemotherapy. Two patients underwent iterative RPLND. In addition to RPLND, patients underwent aortic section with aortic anastomosis (n=6), inferior vena cava resection (n=3), both the latter and the former (n=1), and aortic graft with left nephrectomy (n=2). There were no operative deaths; 3 patients had complications (25%), but none were related to extended procedures. The median hospital stay was 15 days. Median follow up was 59 months (range 10-162). One patient died of metastatic cutaneous melanoma 112 months after RPLND, 10 patients survived and are disease-free, and one patient had a para-aortic recurrence.

CONCLUSION:

A 100% complete resection rate, long-term survival, no mortality, and acceptable morbidity were achieved when vascular surgery and left nephrectomy were combined with standard RPLND for bulky GTS.

• Authors: Mattia Stella, Alessandro Gandini, Pierre Meeus, Ivan Aleksic, Aude Flechon, Claire Cropet, Jean Pierre Droz, Michel Rivoire
• Journal: Urology (Urology) Vol. 79 Issue 2 Pg. 365-70 (Feb 2012) ISSN: 1527-9995 [Electronic] United States
• PMID: 22173179 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers, Tumor
• Bleomycin
• Etoposide
• Cisplatin

Topics

• Adult
• Anastomosis, Surgical
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Aorta, Abdominal (surgery)
• Biomarkers, Tumor (blood)
• Bleomycin (administration & dosage)
• Blood Vessel Prosthesis Implantation
• Cisplatin (administration & dosage)
• Combined Modality Therapy
• Etoposide (administration & dosage)
• Humans
• Lymph Node Excision
• Male
• Nephrectomy
• Retroperitoneal Neoplasms (blood supply, drug therapy, secondary, surgery)
• Retrospective Studies
• Teratoma (blood supply, drug therapy, pathology, secondary, surgery)
• Testicular Neoplasms (surgery)
• Tumor Burden
• Vascular Surgical Procedures (methods, statistics & numerical data)
• Vena Cava, Inferior (surgery)
• Young Adult