PD5-05 SURGICAL MANAGEMENT OF RETROCRURAL DISEASE IN TESTIS CANCER: OUTCOMES AND EVOLUTION OF PRACTICE (2014)

You have accessJournal of UrologyPenis/Testis: Benign & Malignant Disease I1 Apr 2014PD5-05 SURGICAL MANAGEMENT OF RETROCRURAL DISEASE IN TESTIS CANCER: OUTCOMES AND EVOLUTION OF PRACTICE Hristos Kaimakliotis, K Clint Cary, Jose Pedrosa, Timothy Masterson, Richard Bihrle, Kenneth Kesler, and Richard Foster Hristos KaimakliotisHristos Kaimakliotis More articles by this author , K Clint CaryK Clint Cary More articles by this author , Jose PedrosaJose Pedrosa More articles by this author , Timothy MastersonTimothy Masterson More articles by this author , Richard BihrleRichard Bihrle More articles by this author , Kenneth KeslerKenneth Kesler More articles by this author , and Richard FosterRichard Foster More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.408AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Residual retrocrural disease in testis cancer following chemotherapy is a surgical challenge. We sought to assess the outcomes and evolution with surgical management of retrocrural disease in a large single institution experience. METHODS We queried the testicular cancer database at our institution from January 1990 to December 2010 to identify patients who underwent retrocrural dissection. Surgical approach, clinical characteristics, additional procedures, complications and outcomes were evaluated in this cohort of patients with advanced disease. RESULTS Retrocrural dissection was performed in 211 patients. 83 (39%) patients had tumor burden greater than 10cm in the retroperitoneum. Histology of retrocrural disease demonstrated teratoma in 72%, necrosis in 15%, active germ cell cancer in 8%, and malignant transformation in 5%. Retrocrural involvement in 67 patients was managed solely via a midline transabdominal incision, whereas 144 patients required more extensive procedures, some in combination with thoracic surgery. Our surgical approach to the retrocrural space has evolved over time, see Figure. All approaches however have been individualized based on the presence and extent of retroperitoneal and thoracic disease. For retrocrural disease continuous with retroperitoneal disease, earlier approaches favored a single thoracoabdominal incision, or a midline transabdominal incision with a concurrent or staged sternotomy or thoracotomy. A transabdominal/transdiaphragmatic approach at the time of midline retroperitoneal lymph node dissection has been utilized more frequently over time, which involves opening the gastro-hepatic ligament followed by a longitudinal incision in the crus, thereby avoiding a thoracic incision in many cases. Patients undergoing a transabdominal/transdiaphragmatic approach had fewer complications (p=0.006) and required fewer associated surgeries (p=0.001). CONCLUSIONS Metastatic retrocrural testis cancer is surgically challenging. Coordination between urologic and thoracic surgeons for an individualized approach is important. We have found that a transabdominal/transdiaphragmatic approach where appropriate, has resulted in fewer complications and surgeries. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e91 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Hristos Kaimakliotis More articles by this author K Clint Cary More articles by this author Jose Pedrosa More articles by this author Timothy Masterson More articles by this author Richard Bihrle More articles by this author Kenneth Kesler More articles by this author Richard Foster More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...