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Robotic-assisted retroperitoneal lymph node dissection for stage II testicular cancer

Asian Journal of Urology 2024年第1期11卷 121-127页

作者： George McClintock Ahmed S.Goolam Don Perera Ryan Downey Scott Leslie Peter Grimison Henry Woo Peter Ferguson Nariman Ahmadi Department of Urology Chris O'Brien LifehouseSydneyNSWAustralia Department of Anaesthesia Chris O'Brien LifehouseSydneyNSWAustralia The University of Sydney SydneyNSW2006Australia Department of Medical Oncology Chris O'Brien LifehouseSydneyNSWAustralia

Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution.Data were collected on patient and tumour characteristics,intraoperative and postoperative parameters,and functional and oncological outcomes.Descriptive statistics are presented.Results:Nineteen patients were identified;18(94.7%)completed the procedure robotically and one was converted to open surgery;78.9%of patients had stage≥IIB and 12(63.2%)patients had undergone prior chemotherapy.The median operative time was 300(interquartile range[IQR]240-315)min.Median blood loss was 100(IQR 50-175)mL.Median length of stay was 2(range 1-11)days.All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3.The median lymph node yield was 40.5(IQR 38-51)nodes.All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function.One patient had a Clavien-Dindo III complication(chylous ascites requiring drainage).At a median follow-up of 22.3(IQR 16.3-24.9)months,one patient developed retroperitoneal recurrence,which was successfully treated with second-line chemotherapy;no other patients have had recurrences.Conclusion:Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients,offering low morbidity.Early oncological outcomes are promising.Larger cohorts and longer follow-ups are required to validate our institution's findings.

关键词： Retroperitoneal lymph node dissection Robotic surgery testicular cancer Retroperitoneal node dissection

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L.ong-term recovery of normal sexual function in lesticular cancer survivors

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Asian Journal of Andrology 2016年第1期18卷 85-89页

作者： Paolo Capogrosso Luca Boeri Matteo Ferrari Eugenio Ventimiglia Giovanni La Croce Umberto Capitanio Alberto Briganti Rocco Damiano Francesco Montorsi Andrea Salonia Universita Vita-Salute San Raffaele Milan Italy Division of Experimental Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Milan Italy Research Doctorate Program in Urology Magna Graecia University Catanzaro Italy

testicular cancer （TC） is the most common solid cancer in men between the third and fourth decade of life. Due to successful treatment approaches, TC survivors （TCSs） have long life expectancy, but with numerous potential long-term sequelae, including sexual dysfunction. We investigated predictors of long-term normal sexual function （SF） recovery in TCSs. Sociodemographic, medical, and psychometric data were analyzed in 143 Caucasian-European TCSs, who underwent orchiectomy at a single institution. Health-significant comorbidities were scored with the Charlson Comorbidity Index （CCI）. Patients completed the International Index of Erectile Function （IIEF）. Statistical models tested the association between predictors （including age at surgery, body mass index, CCI, and adjuvant therapy： radiotherapy [RT], chemotherapy [CT], CT followed by retroperitoneal lymph node dissection [RPLND] and RPLND alone） and the long-term recovery of normal SF （defined as IIEF-erectile function [EF] ≥26, and sexual desire [SD], intercourse satisfaction [IS] orgasmic function [OF], and overall satisfaction [OS] domain scores in the upper tertiles）. At a mean follow-up of 86 months, 35 （25.5%） TCSs had erectile dysfunction （ED）, with 16 （11.2%） experiencing severe ED. Median time of EF recovery was 60, 60, and 70 months after CT, RT, and RPLND, respectively. Only adjuvant RT emerged as an independent predictor of nonrecovery of normal EF （HR： 0.55, P = 0.01）. Neither adjuvant CT nor CT plus RPLND or RPLND alone significantly impaired the recovery of normal erections. Adjuvant therapy was not associated with impaired recovery of normal sexuality as a whole, considering the IIEF-SD, -OF, -IS, and OS domains.

关键词： chemotherapy erectile dysfunction radiotherapy retroperitoneal lymph node dissection survivors testicular cancer

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Tumour lysis syndrome:A rare acute presentation of locally advanced testicular cancer--Case report and review of literature

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Asian Journal of Urology 2016年第1期3卷 49-52页

作者： Marcus Chow Arianto Yuwono Ronny Tan Department of Urology Tan Tock Seng HospitalSingapore

Tumour lysis syndrome(TLS)is a potentially fatal complication of malignancy or its treatment.This uncommon syndrome comprises laboratory findings of hyperuricaemia,hypocalcaemia,hyperkalaemia and hyperphosphataemia.A literature search revealed a total of eight patients,with testicular cancer,who had TLS.All these patients had metastatic disease.We present a unique case of a 47-year-old gentleman we saw in clinic,who presented with a rapidly growing right groin mass and acute breathlessness,and discuss the diagnosis and management of TLS.TLS is extremely rare in testicular cancer but necessitates the awareness of urologists.TLS can occur spontaneously in testicular malignancy.Cell lysis in a rapidly proliferating germ cell tumour is a possible mechanism.The prompt identification and institution of management for TLS is crucial to improve clinical outcomes.

关键词： Tumour lysis syndrome testicular cancer testicular malignancy

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Androgen receptor gene CAG and GGN repeat lengths as predictors of recovery of spermatogenesis following testicular germ cell cancer treatment

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Asian Journal of Andrology 2017年第5期19卷 538-542页

作者： Karolina Bogefors Yvonne Lundberg Giwercman Jakob Eberhard Olof Stahl Eva Cavallin-Stahl Gabriella Cohn-Cedermark Stefan Arver Aleksander Giwercman Reproductive Medicine Centre Skane University Hospital Malmo Sweden Department of Oncology Skane University Hospital Malmo Sweden Department of Translational Medicine Lund University Malmo Sweden Department of Oncology Skane University Hospital Lund Sweden Radiumhemmet Karolinska HospitalStockholm Sweden Centre of Andrology and Sexual Medicine Karolinska Hospital Stockholm Sweden

Spermatogenesis is an androgen-regulated process that depends on the action of androgen receptor （AR）. Sperm production may be affected in men treated for testicular cancer （TC）, and it is important to identify the factors influencing the timing of spermatogenesis recovery following cancer treatment. It is known that the CAG and GGN repeat numbers affect the activity of the AR; therefore, the aim of this study is to investigate if the CAG and GGN polymorphisms in the AR gene predict recovery of sperm production after TC treatment. TC patients （n = 130） delivered ejaculates at the following time points： postorchiectomy and at 6, 12, 24, 36, and 60 months posttherapy （TO, T6, T12, T24, T36, and T60）. The CAG lengths were categorized into three groups, 〈22 CAG, 22-23 CAG, and 〉23 CAG, and the GGN tracts were also categorized into three groups, 〈23 GGN, 23 GGN, and 〉23 GGN. At T12, men with 22-23 CAG presented with a statistically significantly （P = 0.045） lower sperm concentration than those with other CAG numbers （8.4 × 10^6 ml^-1 vs 16 × 10^6 ml^-1; 95% CI： 1.01-2.65）. This association was robust to omitting adjustment for treatment type and sperm concentration at TO （P= 0.021; 3.7× 10^6 ml^-1 vs 10 × 10^6 ml^-1; 95% CI： 1.13-4.90）. The same trends were observed for total sperm number. The least active AR variant seems to be associated with a more rapid recovery of spermatogenesis. This finding adds to our understanding of the biology of postcancer therapy recovery of fertility in males and has clinical implications.

关键词： androgen receptor CAG and GGN repeat sperm number testicular cancer

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Thromboembolic events in metastatic testicular cancer treated with cisplatin-based chemotherapy

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World Journal of Clinical Oncology 2021年第3期12卷 183-194页

作者： Lisa B E Shields Michael W Daniels Nataliya Mar Arash Rezazadeh Kalebasty Norton Neuroscience Institute Norton HealthcareLouisvilleKY 40202United States Department of Bioinformatics and Biostatistics University of LouisvilleLouisvilleKY 40292United States Division of Hematology/Oncology Department of MedicineUCI Medical CenterOrangeCA 92868United States

BACKGROUND testicular germ cell tumor(TGCT)is the most curable solid tumor and most common cancer among men 18-39 years.While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGCT,it is associated with a high rate of thromboembolic events(TEE).AIM To summarize our single-center experience highlighting patients who were diagnosed with TGCT and received platinum-based chemotherapy,with special attention to those patients who suffered a TEE.METHODS A retrospective analysis of the medical records and imaging studies of 68 consecutive individuals who were diagnosed with TGCT and received platinumbased chemotherapy at our Institution in a metropolitan community between January 1,2014 and December 31,2019.RESULTS A total of 19(28%)patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13(68%)of these patients.Patients with a higher pathologic stage(stage III)were significantly(P=0.023)more likely to experience a TEE compared to patients who had a lower stage.Additionally,patients who were treated with 3 cycles of bleomycine,etoposide,and cisplatin and 1 cycle of etoposide and cisplatin or 4 cycles of etoposide and cisplatin were significantly 5(P=0.02)times more likely to experience a TEE compared to patients who were treated with only 3 cycles of bleomycine,etoposide,and cisplatin.CONCLUSION Due to numerous factors that predispose to a TEE such as large retroperitoneal disease,higher clinical stage,greater number of chemotherapy cycle,central venous catheter,cigarette smoking,and possible cannabis use,high-risk ambulatory patients with TGCT treated with cisplatin-based chemotherapy may benefit from prophylactic anticoagulation.Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are warranted in this young patient population generally devoid of medical co-morbidities.

关键词： Oncology testicular cancer Thromboembolic Cisplatin Pulmonary embolism Thromboprophylaxis

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A comprehensive evaluation of sexual and reproductive outcomes following robot-assisted retroperitoneal lymph node dissection for nonseminomatous germ cell tumor

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Asian Journal of Andrology 2022年第6期24卷 579-583页

作者： Francesco A Mistretta Ottavio de Cobelli Paolo Verze Francesco Botticelli Letizia Jannello Stefano Luzzago Gabriele Cozzi Roberto Bianchi Ettore Di Trapani Matteo Ferro Giovanni Cordima Danilo Bottero Deliu Victor Matei Vincenzo Mirone Gennaro Musi Department of Urology European Institute of OncologyIRccSMilan 20141Italy Department of Oncology and Hemato-Oncology University of MilanMilan 20122Italy Department of Urology University of NaplesFederico IlNaples 80138Italy

Sexual disorders following retroperitoneal pelvic lymph node dissection(RPLND)for testis tumor can affect the quality of life of patients.The aim of the current study was to investigate several different andrological outcomes,which may be influenced by robot-assisted(RA)RPLND.From January 2012 to March 2020,32 patients underwent RA-RPLND for stage I nonseminomatous testis cancer or postchemotherapy(PC)residual mass.Modified unilateral RPLND nerve-sparing template was always used.Major variables of interest were erectile dysfunction(ED),premature ejaculation(PE),dry ejaculation(DE),or orgasm alteration.Finally,fertility as well as the fecundation process(sexual intercourse or medically assisted procreation[MAP])was investigated.Ten patients(31.3%)presented an andrological disorder of any type after RA-RPLND.Hypospermia was present in 4(12.5%)patients,DE(International Index of Erectile Function-5[IIEF-5]<25)in 3(9.4%)patients,and ED in 3(9.4%)patients.No PE or orgasmic alterations were described.Similar median age at surgery,body mass index(BMI),number of nodes removed,scholar status,and preoperative risk factor rates were identified between groups.Of all these 10 patients,6(60.0%)were treated at the beginning of our robotic experience(2012-2016).Of all 32 patients,5(15.6%)attempted to have a child after RA-RPLND.All of these 5 patients have successfully fathered children,but 2(40.0%)required a MAP.In conclusion,a nonnegligible number of andrological complications occurred after RA-RPLND,mainly represented by ejaculation disorders,but ED occurrence and overall sexual satisfaction deficit should be definitely considered.No negative impact on fertility was described after RA-RPLND.

关键词： andrology lymph node excision nonseminomatous germ cell tumor robotics testicular cancer

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Body composition changes following chemotherapy for testicular germ cell tumor:obesity is the long-term problem

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Asian Journal of Andrology 2022年第5期24卷 458-462页

作者： Yuki Takai Sei Naito Hidenori Kanno Atsushi Yamagishi Mayu Yagi Toshihiko Sakurai Hayato Nishida Takuya Yamanobe Tomoyuki Kato Norihiko Tsuchiya Department of Urology Yamagata University Faculty of MedicineYamagata 990-9585Japan

Metabolic syndrome is a long-term complication of systemic chemotherapy for testicular germ cell tumor(TGCT).It is believed to be caused by secondary hypogonadism or toxic medicines because of orchidectomy followed by systemic chemotherapy.In this study,changes in the body composition of patients over time were quantitatively analyzed up to 24 months after chemotherapy.This study retrospectively analyzed 44 patients with TGCT who underwent chemotherapy at our institution from January 2008 to December 2016.Subcutaneous and visceral fat areas and psoas and skeletal muscle areas were measured by computed tomography before and immediately after chemotherapy as well as 3 months,6 months,12 months,and 24 months after chemotherapy.The subcutaneous and visceral fat indices and psoas and skeletal muscle indices were calculated as each area divided by body height squared.The total fat area had already significantly increased 3 months after the initiation of chemotherapy(P=0.004).However,it did not return to prechemotherapeutic levels even at 24 months after chemotherapy.The skeletal muscle area was significantly decreased at the end of chemotherapy(P<0.001);however,the value returned to baseline within 12 months.In multivariable analysis,the prechemotherapeutic skeletal muscle index and number of chemotherapy cycles were independently associated with the reduction of skeletal muscle at the end of chemotherapy(P=0.001 and P=0.027,respectively).In patients with TGCT,skeletal muscle mass decreased during chemotherapy and recovered within 12 months,whereas fat mass progressively increased from the initiation of chemotherapy until 24 months after chemotherapy.

关键词： body composition chemotherapy obesity sarcopenia secondary hypogonadism testicular cancer

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Assessment of Prognostic Factors of Racial Disparities in testicular Germ Cell Tumor Survival in the United States(1992–2015)

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Biomedical and Environmental Sciences 2021年第2期34卷 152-162页

作者： WU Jing JI Yi Bing TANG Bi Wei BROWN Matthew WANG Bao Hua DU Chen Lei DU Jian Shu WANG Xue Mei CAI Li Jun WU Guo Yi ZHOU Yan National Center for Chronic and Non-communicable Diseases Control and Prevention Chinese Center for Disease Control and PreventionBeijing 100050China Inner Mongolia Medical University Hohhot 010110Inner MongoliaChina National cancer Insitiute National Institutes of HealthBethesda 20892MarylandUnited States Shanghai Topgen Biopharm Technology Co. LtdShanghai 201203China Scientific Research Center Shanghai Public Health Clinical CenterFudan UniversityShanghai 201508China State Key Laboratory of Genetic Engineering School of Life SciencesFudan UniversityShanghai 200433China Shanghai-MOST Key Laboratory of Health and Disease Genomics Chinese National Human Genome Center at ShanghaiShanghai 200000China

Objective testicular germ cell tumors(TGCT) are the most common cancer among men aged 15 to 39 years. Previous studies have considered factors related to TGCT survival rate and race/ethnicity, but histological type of the diagnosed cancer has not yet been thoroughly assessed.Methods The data came from 42,854 eligible patients from 1992 to 2015 in the Surveillance Epidemiology and End Results 18. Frequencies and column percent by seminoma and nonseminoma subtypes were determined for each covariates. We used Cox proportional hazard regression to assess the impact of multiple factors on post-diagnostic mortality of TGCT.Results Black males were diagnosed at a later stage, more commonly with local or distant metastases.The incidence of TGCT in black non-seminoma tumors increased most significantly. The difference in survival rates between different ethnic and histological subtypes, overall survival(OS) in patients with non-seminoma was significantly worse than in patients with seminoma. The most important quantitative predictor of death was the stage at the time of diagnosis, and older diagnostic age is also important factor affecting mortality.Conclusion Histological type of testicular germ cell tumor is an important factor in determining the prognosis of testicular cancer in males of different ethnic groups.

关键词： testicular cancer Germ cell tumor Race Survival rate Survival analysis

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Mesenteric metastases from mature teratoma of the testis:A case report

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Asian Journal of Urology 2020年第3期7卷 322-325页

作者： Zoe Loh Todd G.Manning Jonathan S.O’Brien Marlon Perera Nathan Lawrentschuk Department of Surgery University of MelbourneAustin HealthMelbourneAustralia The Young Urology Researchers Organisation(YURO) Australia Faculty of Medicine University of QueenslandBrisbaneAustralia Department of Surgical Oncology Peter MacCallum Cancer CentreMelbourneAustralia Olivia Newton-John cancer Research Institute MelbourneAustralia

Metastatic spread of testicular cancer has been well documented,with 95% of cases involving para-aortic retroperitoneal lymph nodes.Mesenteric lymphatic basins do not lie within the canonical drainage pathway of the testes and represent a rare site of metastasis.Various mechanisms of spread to the mesentery have been described,including direct extension and haematogenous dissemination.We present a case of a previously-well 43-year-old man who presented with right scrotal discomfort and intermittent lower back pain,who was found to have mesenteric metastases from a non-seminomatous germ cell tumour of the testis.Managing lymphadenopathy that lies outside of standard resection templates remains a complex surgical challenge.Here we present the first case in the English medical literature with co-existing supradiaphragmatic axillary and mediastinal nodal disease.

关键词： Nonseminomatous germ cell tumour Retroperitoneal lymph node dissection Mesentery Metastases testicular cancer

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Fertility outcome of patients with testicular tumor： before and after treatment

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Asian Journal of Andrology 2014年第1期16卷 107-111页

作者： Ping Ping Ben-Hong Gu Peng Li Yi-Ran Huang Zheng Li Department of Urology Shanghai Human Sperm Bank Shanghai Institute of Andrology Department of Surgery Shanghai Pudong District Traditional Chinese Medicine Hospita Reproductive Genetics Shanghai China.

testicular cancer （TC） is the most curable type of cancer, with a survival rate of more than 95%. Oncologists are faced with the challenge that gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. Our aim was to investigate the long-term effects of TC treatments on male fertility and on the offspring of patients who had received these treatments. Between January 1996 and December 2010, 125 eligible patients, ranging from 18 to 54 years （median age 36.3 _＋ 15.7）, with unilateral TC underwent surgery, chemotherapy or radiotherapy at our center. Some of these patients had their semen samples cryopreserved in the Shanghai Human Sperm Bank. The clinical data were evaluated, and questionnaire and telephone follow-up surveys were given to all patients. The data were analyzed to determine the patients＇ fertility status pre- and posttreatment. Of the 125 eligible patients, 93.6% （117/125） were accessible and were evaluated. Among 81 men who were married before diagnosis, 21 had conceived successfully before diagnosis and six reported azoospermia. Posttreatment conception was attempted by 73 men; of these, 16 conceived naturally and 19 conceived by artificial reproductive techniques, resulting in 37 healthy babies with no congenital malformations. Of the patients who had not conceived before treatment, 21.9% （21/96） banked their sperm and 23.8% of these patients （5/21） subsequently used the banked sperm. Retroperitoneal lymph node dissection, chemotherapy and radiotherapy were the most highly correlated with lack of conception to TC patients with the desire for biological conception. There is no birth defects or childhood malignancies. post-TC treatment. Sperm banking should be recommended evidence to suggest that TC treatments are associated with

关键词： chemotherapy fertility radiotherapy sperm bank testicular cancer

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