Pomen retroperitonealne limfadenektomije pri zdravljenju neseminomskih tumorjev mod
The significance of retroperitoneal lymph node dissection in the treatment of non-seminomatous testicular tumors

  • Andrej Kmetec
Keywords: retroperitoneal lymph node dissection, non-seminomatous testicular tumors, testicular tumors, NSGCT

Abstract

V zadnjih letih je uspešna kemoterapija pri neseminomskih germinalnih tumorjih mod (NSGCT) zmanjšala pomen retroperitonealne limfadenektomije (RPLA). Kljub temu ima skoraj 30 % bolnikov po kemoterapiji še preostanek tumorja, kjer lahko v 60 % do 70 % histološko najdemo živo tumorsko tkivo. Merila, ki bi izključila potrebo po RPLA (zmanjšanje tumorja za več kot 90 %, negativni tumorski označevalci in preostanek tumorja manjši kot 2 cm), niso povsem zanesljiva, zato RPLA priporočajo tudi pri normalnih tumorskih označevalcih, če je preostanek tumorja večji kot 1 cm do 1,5 cm. Velikosti preostanka tumorja se je prilagodila tudi tehnika operacije, da bi tako zmanjšali pozne posledice operacije in izboljšali kakovost življenja bolnikov. Navadno naredimo enostransko ali enostransko razširjeno RPLA, le pri redkih bolnikih je možno narediti RPLA z ohranitvijo živcev. Pozna posledica operacije je predvsem retrogradna ejakulacija, vendar jo z enostransko RPLA lahko preprečimo pri 80 % bolnikov.

Abstract (Eng)

In the last years, effective chemotherapy in non-seminomatous germ cell tumors (NSGCT) diminished the significance of retroperitoneal lymph node dissection (RLND). Nearly 30% of patients have residual tumor after chemotherapy which harbor 60-70% of viable cancer and 30-40% of necrosis or fibrous tissue. The criteria to avoid RPLA, such as reduction of tumor volume by more than 90%, negative tumor markers and residual mass of less than 2 cm in size, are not sufficiently accurate. Postchemotherapy RPLND is recommended in the patients with normal tumor markers and residual tumor of the size ranging from 1-1.5 cm because of higher probability for active disease. According to tumor mass, considerable modifications in the technique of operation evolved to minimize late consequences of surgery and to improve quality of life. We perform one-side or one-side extended RPLND, while nerve-sparing surgery can be done only in specific patients. Late consequence is the retrograde ejaculation which can be prevented in 80% with unilateral RPLND
Published
2010-12-15
How to Cite
Kmetec, A. (2010). The significance of retroperitoneal lymph node dissection in the treatment of non-seminomatous testicular tumors. Onkologija : A Medical-Scientific Journal, 14(2), 134-136. Retrieved from https://revijaonkologija.si/Onkologija/article/view/301
Section
Review Article
Page
134-136