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Title: Long term surgical and oncological outcome of non seminomatous germ cell tumors with retroperitoneal lymph nodes dissection in a specialised hospital of Kingdom of Saudi Arabia.

Biography:

Nouman Khan has completed his MBBS from Khyber Medical College Peshawar and Fellowship in Urology from the College of Physicians and Surgeon Pakistan (FCPS-Urology) in December 2015. He worked as Registrar Urology at North West General Hospital Peshawar for one year and later moved to Lahore city for fellowship in Urological Oncology at Shaukat Khanum Cancer Hospital Lahore. He is currently working as assistant consultant urology at King Faisal Specialist Hospital & Research Centre, Saudi Arabia. He has published 12 papers in Pakistan and international journals. Three articles are ready for publication.

Abstract

Background

Testicular cancer is the most common solid tumor in young men aged between 20 and 35 years old.

Many of patient with nonseminomatus germ cell tumor will require further management. Retroperitoneal Lymph Node Dissection (RPLND) remains an integral component in the ultimate care of such patients, either alone or in combination of chemotherapy. Literature regarding long-term oncologic outcome of nonseminomatus germ cell tumor after retroperitoneal dissection surgery is deficient in the Saudi Arabia population.

Objectives

The main objective of this research was to determine the long-term surgical and oncological outcomes of NSGCT after retroperitoneal lymph nodes dissection and to determine the clinical and pathological factors associated with long-term survival.

Methods

This study is a retrospective case series, we included all the seven adult patients who underwent Retroperitoneal Lymph Node dissection for nonseminomatus germ cell tumor in our hospital, from January 2010 to April 2021.

The data using HIS power chart in the form of history, demography, labs and radiological findings, staging of the disease, chemotherapy and radiotherapy status, surgery procedure details and surgery related per OP, post op acute and chronic complications, surgery related morbidity and mortality, follow up Labs and radiological findings, disease recurrence in months and overall survival in months.  The data was analysed in SPSS 23 for overall and disease free survivals in months using life table and Kaplan Mires curve. 

Results                                                              

9 patient underwent RPLND for NSGCT during the study period, Mean age was 28. years ( ± 5.4 SD ). . Yolk sac and embryonal cell carcinoma was the most common variant in testicular biopsies. Using AJCC 8^th Edition NSCT staging classification, three patients had 3A stage, 3 patients had 3B stage while one patient had 3C, one 1S stage and one 2B stage. All patients received NeoAdjuvant chemotherapy with reduction in retroperitoneal nodes size in 4 patients, no response noted in 4 patients and 1 patient had progression of nodes size post chemotherapy. No morbidity or mortality noted post RPLND, mean hospital stay was 8 days. All patients needed intervention in form of blood transfusion or IV antibiotics hence making the Calvin Dindo score of 2 in all the patients.  66.7% of the RPLN resected harboured cancer, all of them had teratoma as major component with one patient had yolk sac tumor and 1 had choriocarcinoma in combination with teratoma, on histopathology reports. Post treatment the median overall survival was 26 months and disease free survival was 21 months. The 1 year overall survival was 86% and 5 years survival was 66.7% using Kaplan Myers survival chart. Embryonal cell carcinoma had good prognosis over yolk sac tumor, the 3 years overall survival for the two variant were 66% vs 50% respectively.

Conclusion

Retroperitoneal lymph nodes dissection is safe procedure with very low morbidity, mortality and post OP complications. It achieves reasonable oncological results with good overall and disease free survival.