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Reduzierte Morbidität bei der Resektion von Residualtumoren nach Chemotherapie beim Seminom

Reduced morbidity in resection of residual tumors after chemotherapy for seminoma

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Zusammenfassung

Hintergrund

Die Residualtumorresektion beim Hodentumor nach Chemotherapie ist komplikationsträchtig mit insgesamt rückläufigen Begleitresektionen. Bei Seminomen ist die Indikation zur Residualtumorresektion zurückhaltend zu stellen. Dementsprechend sind die Daten hierzu reduziert. Wir untersuchten die Häufigkeit von Begleitresektionen und therapieassoziierten Komplikationen bei Patienten mit Seminomen und verglichen diese mit Patienten mit einem nicht-seminomatösen Keimzelltumor (NSKZT).

Patienten und Methoden

In unserer retrospektiven Analyse konnten wir die Daten von insgesamt 580 Patienten erheben, die in 4 Zentren erhoben wurden. 43 Patienten hatten ein lokal fortgeschrittenes Seminom und 537 einen NSKZT. Der operative Zugang erfolgte über eine mediane Laparotomie oder über einen thorakoabdominellen Zugang in Abhängigkeit der Residualtumorlokalisation.

Ergebnisse

Bei 43 Patienten mit einem Seminom wurden bei 7 Patienten (16,3 %) insgesamt 13 Begleiteingriffe durchgeführt. Es gab nur 3 intra- und 2 postoperative Komplikationen und keinen signifikanten Unterschied zwischen Patienten mit einem Seminom und einem NSKZT in Bezug auf Begleiteingriffe und postoperative Komplikationen (p = 0,49 und p = 0,133). In der Seminomgruppe traten signifikant weniger intraoperative Komplikationen auf (p = 0,001).

Schlussfolgerung

Die Residualtumorresektion ist eine herausvordernde Operation. Im Vergleich zu älteren Serien gibt es zwischen Seminom und NSKZT keinen Unterschied in Morbidität und Mortalität. Die Indikation zur Residualtumorresektion beim Seminom ist reduziert, falls erforderlich kann diese jedoch sicher durchgeführt werden.

Abstract

Background

Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) is associated with complications and decreased adjunctive surgery. Little data are available concerning PC-RPLND in patients with advanced seminomas and residual retroperitoneal tumor lesions. We examined intra- and postoperative complications as well as the frequency of adjunctive surgeries in patients with seminoma and compared the data to a cohort of patients with non-seminomatous germ cell tumors (NSGCT) who underwent PC-RPLND.

Patients and methods

In our retrospective analysis, 580 patients (43 patients with advanced seminomas and 537 patients with NSGCT) underwent PC-RPLND between 1989 and 2010. The surgical approach was preferred via midline incision or a thoracoabdominal approach depending on the location of the residual tumor.

Results

Of the 43 patients with seminoma, a total number of 13 adjunctive surgeries were performed in 7 patients. There were only three intraoperative complications, two postoperative complications (prolonged intestinal paralyses). There were no significant differences in adjunctive surgeries and postoperative complications (p=0.49 and p=0.133) between the two groups. There were significantly fewer intraoperative complications in favor of seminomas (p=0.001).

Conclusion

PCRLND in seminomas and NSGCT is a demanding surgical intervention. In contrast to other series we did not find significant differences in the two patient groups concerning adjunctive surgeries and postoperative complications. The indication for PCLND in patients with seminoma is limited, but if necessary it can be performed safely in experienced centers.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Pfister, D. Porres, M. Vsevolod und A. Heidenreich geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Urologische Klinik, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    D. Pfister, D. Porres, V. Matveev & A. Heidenreich

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  1. D. Pfister
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  2. D. Porres
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  3. V. Matveev
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  4. A. Heidenreich
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Correspondence to D. Pfister.

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Pfister, D., Porres, D., Matveev, V. et al. Reduzierte Morbidität bei der Resektion von Residualtumoren nach Chemotherapie beim Seminom. Urologe 54, 1402–1406 (2015). https://doi.org/10.1007/s00120-014-3708-9

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