Presentation Authors: Andreas Hiester*, Alessandro Nini, Anna Fingerhut, Robert große Siemer, Christian Winter, Peter Albers, Achim Lusch, Düsseldorf, Germany
Introduction: This study aims to evaluate the oncological and functional outcome of bilateral versus unilateral template resection in patients with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for non-seminoma.
Methods: Between 2003 and 2018, 504 RPLNDs have been performed in 434 patients. The database of consecutive patients was queried to identify 171 patients with PC-RPLND after 1st line chemotherapy for a non-seminoma with or without bilateral template resection. Re-DoÂ´s, late relapse, salvage patients and thoraco-abdominal approaches were excluded. Indication for a template resection was a unilateral residual mass mainly less than 5 cm as published (Heidenreich et al. 2009). Descriptive statistics were used to report preoperative features, post-operative outcomes and patterns of recurrence. Kaplan-Meier analyses were used to describe recurrence- and cancer specific mortality-free survival rates.
Results: 90 and 81 patients underwent unilateral and bilateral resection, respectively. Median size of residual mass was 7 cm for bilateral and 4 cm for unilateral template resection. Clinical stage II and III were present in 31% and 69% of patients, respectively. Median follow-up was 14.5 months (IQR 3.3 â€“ 37.6). Recurrences were observed in 5 and 18 patients for the unilateral and bilateral approach, respectively. Only five recurrences occurred in the retroperitoneum, 3 in-field and 1 outside-field recurrence after a bilateral approach, and only one outside field in a template approach. The 1- and 2-year recurrence-free survival rates were 91% and 91%, 77% and 72% for patients treated with unilateral template and bilateral resection, respectively (p < 0.0008). Median time to recurrence was 9.5 and 9 months in template and bilateral PC-RPLND group, respectively.As expected, adjunctive procedures were performed in 56 patients (33%) and were significantly more frequent in bilateral PC-RPLND group (44% vs. 22%, p < 0.002). High-grade complication rate (Clavien-Dindo â‰¥ III) was 3% and 9% in unilateral template and bilateral PC-RPLND group, respectively (p=0.2). In 87% and 44% nerve-sparing was achieved in unilateral and bilateral approaches, respectively. In patients with complete follow-up data, the preservation rate of antegrade ejaculation was significantly higher in the unilateral group.
Conclusions: Unilateral template PC-RPLND in the 1st line setting is oncologically safe when the residual mass is < 5 cm. Nerve-sparing and preservation of antegrade ejaculation with a unilateral resection is significantly better.