Primary retroperitoneal lymph node dissection as treatment for low-volume metastatic seminoma in a population-based cohort: the Swedish Norwegian testicular cancer group experience

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Primary retroperitoneal lymph node dissection as treatment for low-volume metastatic seminoma in a population-based cohort : the Swedish Norwegian testicular cancer group experience

Thor, Anna (author): Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden

Negaard, Helene F.S. (author): Department of Oncology, Oslo University Hospital, Oslo, Norway

Grenabo Bergdahl, Anna (author): Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden

Almås, Bjarte (author): Department of Urology, Haukeland University Hospital, Bergen, Norway

Melsen Larsen, Signe (author): Department of Urology, Oslo University Hospital, Oslo, Norway

Lundgren, Per-Olof (author): Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden

Gerdtsson, Axel (author): Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden

Halvorsen, Dag (author): Department of Urology, St. Olavs University Hospital, Trondheim, Norway

Johannsdottir, Berglind (author): Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden

Jansson, Anna K. (author): Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden

Hellström, Martin (author): Umeå universitet,Onkologi

Wahlqvist, Rolf (author): Department of Urology, Oslo University Hospital, Oslo, Norway

Langberg, Carl W. (author): The Cancer Centre, Oslo University Hospital, Oslo, Norway

Hedlund, Annika (author): Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden

Akre, Olof (author): Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

Glimelius, Ingrid (author): Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden

Ståhl, Olof (author): Department of Oncology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden

Haugnes, Hege Sagstuen (author): Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UIT – The Arctic University of Norway, Tromsø, Norway

Cohn-Cedermark, Gabriella (author): Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology - Pathology, Karolinska Institute, Stockholm, Sweden

Kjellman, Anders (author): Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden

Tandstad, Torgrim (author): The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

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Elsevier, 2024
2024
English.
In: European Urology Open Science. - : Elsevier. - 2666-1691 .- 2666-1683. ; 65, s. 13-19

Related links:: https://doi.org/10.1...; show more...; https://umu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background and objective: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy.Methods: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).Key findings and limitations: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13–24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16–30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4–14). PFS was 90% (95% confidence interval: 0.86–1) and OS was 100% at 24 mo.Conclusions and clinical implications: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.Patient summary: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

Keyword

Germ cell cancer
Metastatic
Retroperitoneal
Retroperitoneal lymph node dissection
Robotic surgery
Seminoma
Testicular

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Urology and Neph ...

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By the university: Umeå University

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