Critical evaluation of modified templates and current trends in retroperitoneal lymph node dissection.
Curr Urol Rep
; 14(5): 511-7, 2013 Oct.
Article
en En
| MEDLINE
| ID: mdl-23907555
Retroperitoneal lymph node dissection (RPLND) is a critical aspect of staging and treatment of nonseminomatous germ cell tumors (NSGCTs) of the testis. RPLND achieves cure in a majority of patients with low-volume metastatic disease and minimizes the need for chemotherapy. Initial surgical approaches to RPLND, involving wide limits to dissection, were associated with high rates of retrograde ejaculation and significant overall morbidity. Evolving modified RPLND templates helped reduce rates of retrograde ejaculation but may be associated with a 3 %-23 % risk of unresected metastasis. Modified templates have become a standard of care in primary RPLND with low-volume metastatic disease. Only highly select patients at specialized centers should undergo modified template RPLND in the postchemotherapy setting, because risks of unresected disease are higher than in the primary setting. Bilateral RPLND optimizes cancer control and can preserve antegrade ejaculation if nerve sparing is performed. We also briefly discuss minimally invasive approaches to RPLND.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Testiculares
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Orquiectomía
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Neoplasias de Células Germinales y Embrionarias
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Procedimientos Quirúrgicos Mínimamente Invasivos
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Escisión del Ganglio Linfático
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Ganglios Linfáticos
Límite:
Humans
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Male
Idioma:
En
Revista:
Curr Urol Rep
Asunto de la revista:
UROLOGIA
Año:
2013
Tipo del documento:
Article
Pais de publicación:
Estados Unidos