演題抄録

口演

開催概要
開催回
第58回・2020年・京都
 

当院における進行期胚細胞腫瘍に対する後腹膜リンパ節郭清術の臨床的検討

演題番号 : O61-4

[筆頭演者]
新田 聡:1 
[共同演者]
河合 弘二:2、神鳥 周也:1、河原 貴史:1、小島 崇宏:1、西山 博之:1

1:筑波大学附属病院・腎泌尿器外科、2:国際医療福祉大学成田病院・腎泌尿器外科

 

Patients with advanced germ cell tumor (GCT) have a favorable prognosis when treated appropriately with cisplatin-based chemotherapy and surgery. The post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is the most common surgery and an essential part of management. Since PC-RPLND needs complex surgical procedures, most of guidelines recommend referral to high-volume centers. Since a centralized management is preferred not only for RPLND but also for chemotherapy, we have introduced risk-adapted management for advanced GCT patients through a regional network involving Tsukuba University Hospital (TUH) and branch hospitals in Ibaraki Prefecture.
In this system, community hospitals are recommended to refer all advanced patients to key branch hospitals or TUH, furthermore, patients with poor-risk disease or having risk factors for chemotherapy are principally referred to TUH. Additionally, implementation of second-line or subsequent chemotherapy is principally centralized to TUH. As results, number of PC-RPLND cases, especially those of PC-RPLND after second-line or more chemotherapy is increasing in TUH.
Until 1990s, distribution in histology of PC-RPLND has been reported to necrosis/fibrosis in 40-45%, teratoma in 40% and viable germ cell cancer in 15%-20%. But in more recent years, several studies reported that incidence of remaining viable germ cell cancer declined to 6.0% to 9.2%. But, around 60% to 100% of patient participated in those studies were having good-risk disease, and most of them underwent RPLND after the first-line chemotherapy. Therefore, relatively few recent data exist on PC-RPLND after multiple regimens of chemotherapy for more advanced GCT patients.
We retrospectively analyzed clinical outcome and pathological findings of 66 patients undergoing PC-RPLND at TUH between 2005-2019. In this study, 77% of patients had intermediate- or poor-risk disease, and 53% of patients had received second-line or more chemotherapy before PC-RPLND.

キーワード

臓器別:前立腺・男性生殖器

手法別:手術療法

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