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Stellenwert der retroperitonealen Lymphadenektomie beim Keimzelltumor

Value of retroperitoneal lymphadenectomy for germ cell cancer

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Zusammenfassung

Die retroperitoneale Lymphadenektomie (RLA) hat ihren festen Platz in der Behandlung des nichtseminomatösen Keimzelltumors. Allerdings hat sich die Indikation verschoben. Wurde sie lange Zeit als Standardmaßnahme im klinischen Stadium I durchgeführt, so ist sie bei dem heutigen risikoadaptierten Vorgehen hier kaum noch indiziert. Unbedingt erforderlich ist die Operation jedoch bei Restbefunden nach Chemotherapie. Beim Spätrezidiv hat die Operation einen höheren Stellenwert als die Chemotherapie unabhängig von einer Tumormarkererhöhung. Außerdem kann die Operation als Salvagemaßnahme bei ca. 25% der Betroffenen zu einer deutlichen Lebensverlängerung führen. Technisch kann man offen oder laparoskopisch operieren, wobei die Indikationen zum laparoskopischen Vorgehen bei der RLA fest umschrieben sind.

Abstract

Retroperitoneal lymph node dissection (RPLND) is an integral part in the therapy of nonseminomatous germ cell tumors. However, there has been a shift concerning the indication. For a long period RPLND was the primary choice in clinical stage I nonseminoma. Nowadays a risk-adapted strategy is preferred. RPLND is obligatory after finishing chemotherapy in metastasized patients if residual tumor is seen. In cases of a late relapse surgery is much more important than chemotherapy independent of increased tumor markers. RPLND can also be a salvage strategy in chemoresistant patients. About 25% of these patients have a long-term benefit. Open or laparoscopic surgery can be performed, though the indications for laparoscopy are small.

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Literatur

  1. Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part I. Eur Urol 53: 478–496

    Article  PubMed  Google Scholar 

  2. Albers P, Siener R, Kliesch S et al (2003) Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German testicular cancer study group trial. J Clin Oncol 21: 1505–1512

    Article  PubMed  Google Scholar 

  3. Ondrus D, Matoska J, Belan V et al (1998) Prognostic factors in clinical stage I nonseminomatous germ cell testicular tumors: rationale for different risk-adapted treatment. Eur Urol 33: 562–566

    Article  PubMed  CAS  Google Scholar 

  4. Heidenreich A, Schenkmann NS, Sesterhenn IA et al (1997) Immunhistochemical expression of Ki-67 to predict lymph node involvement in clinical stage I nonseminomatous germ cell tumors. J Urol 158: 620–625

    Article  PubMed  CAS  Google Scholar 

  5. Read G, Stenning SP, Cullen MH et al (1992) Medical research council prospective study of surveillance for stage I testicular teratoma. Medical research council testicular tumors working party. J Clin Oncol 10: 1762–1768

    PubMed  CAS  Google Scholar 

  6. Albers P, Albrecht W, Algaba F et al (2008) Guidelines on testicular cancer. Intern J Urol 15(9): 821-826

    Article  Google Scholar 

  7. Donohue JP, Thornhill JA, Foster RS et al (1993) Retroperitoneal lymphadenectomy for clinical stage a testis cancer (1965-1989): modifications of technique and impact on ejaculation. J Urol 149: 237–243

    PubMed  CAS  Google Scholar 

  8. Oliver RT, Nason MD, Mead GM et al (2005) Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomized trial. Lancet 366: 293–300

    Article  PubMed  CAS  Google Scholar 

  9. Williams SD, Stablein DM, Einhorn LH et al (1987) Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. New Engl J Med 317: 1433–1438

    Article  PubMed  CAS  Google Scholar 

  10. Weißbach L, Bussar-Maatz R, Flechtner H et al (2000) RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumors? Results of a prospective multicenter trial including quality of life assessment. Eur Urol 37: 583–594

    Article  Google Scholar 

  11. de Wit M, Brenner W, Hartmann M et al (2008) (18F)-FDG-PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol (Epub ahead of print)

  12. De Santis M, Becherer A, Bokemeyer C et al (2004) 2-18fluoro-deoxy-D- glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update from the multicenter SEMPET trial. J Clin Oncol 22: 1034–1039

    Article  Google Scholar 

  13. Wood DP, Herr HW, Heller G et al (1992) Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ cell tumors. J Urol 148: 1812–1816

    PubMed  Google Scholar 

  14. Aprikian AG, Herr HW, Bajorin DF et al (1995) Resection of postchemotherapy residual masses and limited retroperitoneal lymphadenectomy in patients with metastatic testicular nonseminomatous germ cell tumors. Cancer 74: 1329–1334

    Article  Google Scholar 

  15. Herr HW (1997) Does necrosis on frozen-section analysis of a mass after chemotherapy justify a limited retroperitoneal resection in patients with advanced testis cancer? Br J Urol 80: 653–657

    PubMed  CAS  Google Scholar 

  16. Rabbani F, Goldenberg SL, Gleave ME et al (1998) Retroperitoneal lymphadenectomy for post-chemotherapy residual masses: is a modified dissection and resection of the residual mass sufficient? Br J Urol 81: 295–300

    PubMed  CAS  Google Scholar 

  17. Sheinfeld J (2002) The role of adjunctive postchemotherapy surgery for nonseminomatous germ-cell tumors: current concepts and controversies. Semin Urol Oncol 20: 262–271

    Article  PubMed  Google Scholar 

  18. Shahidi M, Norman AR, Dearnaley DP et al (2002) Late recurrences in 1263 men with testicular germ cell tumors. Cancer 95: 520–530

    Article  PubMed  Google Scholar 

  19. Ronnen EA, Kondagunta GV, Bacik J et al (2005) Incidence of late relapse germ cell tumor and outcome to salvage chemotherapy. J Clin Oncol 23: 6999–7004

    Article  PubMed  Google Scholar 

  20. Oldenburg J, Alfsen GC, Waehre H, Fossa SD (2006) Late recurrences of germ cell malignancies: a population based experience over three decades. Br J Cancer 94: 820–827

    Article  PubMed  CAS  Google Scholar 

  21. Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 53: 497–513

    Article  PubMed  Google Scholar 

  22. Albers P, Ganz A, Hannig E et al (2000) Salvage surgery of chemorefractory germ cell tumors with elevated tumor markers. J Urol 164: 381–384

    Article  PubMed  CAS  Google Scholar 

  23. Rassweiler JJ, Frede T, Lenz E et al (2000) Longterm experience with laparoscopic retroperitoneal lymph node dissection in the management of low-stage testis cancer. Eur Urol 37: 251–260

    Article  PubMed  CAS  Google Scholar 

  24. Steiner H, Peschel R, Janetschek G et al (2004) Long-term results of laparoscopic retroperitoneal lymph node dissection: a single-center 10-year experience. Urology 62: 550–555

    Article  Google Scholar 

  25. Corvin S, Sturm W, Kuczyk M et al (2005) Laparoscopic retroperitoneal lymphadenectomy in the management of low-stage testicular cancer: technique and results. Minim Invasive Ther Allied Technol 14: 52–56

    Article  PubMed  CAS  Google Scholar 

  26. Peschel R, Gettman MT, Neururer R et al (2002) Laparoscopic retroperitoneal lymph node dissection: description of the nerve-sparing technique. Urology 60: 339–343

    Article  PubMed  Google Scholar 

  27. Janetschek G, Hobisch A, Peschel R et al (2000) Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular carcinoma: Long-term outcome. J Urol 163: 1793–1796

    Article  PubMed  CAS  Google Scholar 

  28. Höltl L, Peschel R, Knapp R et al (2002) Primary lymphatic metastatic spread in testicular cancer occurs ventral to the lumbar vessels. Urology 59: 114–118

    Article  PubMed  Google Scholar 

  29. Palese MA, Su LM, Kavoussi LR (2002) Laparoscopic retroperitoneal lymph node dissection after chemotherapy. Urology 60: 130–134

    Article  PubMed  Google Scholar 

  30. Janetschek G, Hobisch A, Hittmair A et al (1999) Laparoscopic retroperitoneal lymphadenectomy after chemotherapy for stage IIB nonseminomatous testicular carcinoma. J Urol 161: 477–481

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf, Oberdießemerstraße 94, 47805, Krefeld, Deutschland

    S. Krege

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Krege, S. Stellenwert der retroperitonealen Lymphadenektomie beim Keimzelltumor. Urologe 48, 32–36 (2009). https://doi.org/10.1007/s00120-008-1757-7

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