chapter 77 Testicular tumors

Question 1

Why are the vas deferens and gonadal vessels ligated separately during radical orchiectomy?

Answer 1

allow easier identification during future RPLND.

Question 2

most common aux procedure in RPLND?

Answer 2

LEFT NEPHRECTOMY

Question 3

What percentage of presumed extragonadal GCT patients have intratubular germ cell neoplasia?

Answer 3

42%

Question 4

What is intratubular germ cell neoplasia (ITGCN)?

Answer 4

pre-invasive lesion where abnormal germ cells are confined inside seminiferous tubules without invading surrounding tissue.

Question 5

approximate incidence of synchronous bilateral testicular tumors?

Answer 5

Around 1%.

Question 6

high risk for left nephrectomy

Answer 6

due to para aortic and left renal hilum manipulation

Question 7

% of PC RPLND need vascular procedures

Answer 7

15%

Question 8

msot commonly injured vessul

Answer 8

IVC

Question 9

Preferred for large vascular repairs

Answer 9

PTFE or Dacron graft

Question 10

<25% IVC narrowin managed?

Answer 10

prmary repair or lateral venorraphy

Question 11

Disease free survival after aortic replacement?

Answer 11

33%

Question 12

approx rate of hepatic mets?

Answer 12

~6%

Question 13

alternative tx for liver mets <3cm?

Answer 13

microwave ablation

Question 14

most common histo in pelvic resection

Answer 14

teratome 55%

Question 15

what % of testiculr cancer present with supradiaphragmatic disease?

Answer 15

10-20

Question 16

proportion of mediatinal mets are in the anterior mediastiunum, often indicating a primary mediastinal gct

Answer 16

20

Question 17

vertebral level might you extend the incision with a sternal split for superior masses

Answer 17

T8

Question 18

5 year survival reported in the FADEL et al combined retropertioneal/posterior resection series

Answer 18

92

Question 19

What defines clinical complete remission (CCR) after induction chemotherapy?

Answer 19

Normal serum markers, no residual mass > 1 cm on imaging

Question 20

Which patients is CCR management relevant

Answer 20

STage II or III after indction cisplatin-based chemo

Question 21

% of patients achieve ccr after induction chemo

Answer 21

70%

Question 22

indiana university for patients in ccr management

Answer 22

observe

Question 23

in the MSKCC series, what percent of <1 cm residual masses after chemo still contained teratoma?

Answer 23

~22%

Question 24

hat is the most common historical complication of full bilateral RPLND?

Answer 24

anejeculation due to sympathetic nerve injury

Question 25

What was the Eggener et al. (MSKCC) finding on simulated modified templates?

Answer 25

3–23% of node-positive patients would have been missed, especially on right side.

Question 26

What is the standard surgical approach for post-chemotherapy RPLND?

Answer 26

Full bilateral infrahilar template dissection.

Question 27

Under what conditions can modified PC-RPLND templates be considered?

Answer 27

A: Small (<5 cm), unilateral mass confined to primary landing zone, normal markers, good/intermediate risk.

Question 28

What is the recommended management for pN0 patients after primary RPLND?

Answer 28

observation

Question 29

What is the typical next step for pN1 patients after primary RPLND?

Answer 29

observation, if px reliable for ffup

Question 30

What key factors have failed to reliably predict relapse after primary RPLND?

Answer 30

nodl bulk, number, histo, extranodal extension

Question 31

When is modified tempalte RPLND appropriate?

Answer 31

In primary RPLND (stage I or low volume stage II NSGCT) without bulky or cross midline disease

Question 32

when is full bilateral infrahilar rplnd mandatory?

Answer 32

For PC RPLND, for residual rp masses, this due to unpredictable contralateral spread

Question 33

3 main histologic outcomes at RC RPLND

Answer 33

finrosis/ necrosis teratoma GCT (viable tumor)

Question 34

histology best prognosis at PC RPLND

Answer 34

Fibrosis/ necrosis, 90% long term survical, no further adjuvant chemo

Question 35

adjuvant chemo after PC RPLND neccesary?

Answer 35

if viable FCT is found, if >10% viable tumor or incomplete resection, or IGCCG intermediate/poor risk

Question 36

what is salvage rplnd

Answer 36

surgery after second line salvage chemoT when residual retroperitenal mass remains and tumor markers have normalized

Question 37

Desperation RPLND

Answer 37

Surgery performed when tumor markers remain elevated after all chemotherapy options are exhausted, in highly selected patients with limited, resectable disease.

Question 38

What is redo (reoperative) RPLND?

Answer 38

Surgery performed after technical failure or local recurrence following prior RPLND, requiring complete re-dissection and vessel mobilization

Question 39

5 year survival for salvage Rplnd

Answer 39

60-75

Question 40

histology often found after salvage RPLND

Answer 40

40-44% viable malig

Question 41

main surgical template used for salvage and desperation rplnd

Answer 41

: Full bilateral infrahilar dissection, due to unpredictable contralateral spread and bulky disease.

Question 42

: What factors predict poor outcomes after desperation RPLND?

Answer 42

1 Elevated β-hCG before surgery 2 prior salvage chemo 3 repeat RPLND 4 incomplete resection.

Question 43

When should patients with elevated tumor markers after first-line chemotherapy undergo surgery?

Answer 43

They should first receive salvage chemotherapy; surgery is only considered after markers normalize or as desperation RPLND if chemo fails.

Question 44

After chemotherapy, at what residual seminoma mass size (< or ≥) should you perform FDG-PET to assess viability?

Answer 44

more than or equal to 3 cm

Question 45

What is the approximate cancer-specific and overall survival for stage II SCST after RPLND?

Answer 45

30% css and OS

Question 46

what proportion of testicular cancer pxs already have abnomral semen parameters at diagnosis

Answer 46

40-60

Question 47

Q: What is the paternity rate after orchiectomy plus primary RPLND (non–nerve-sparing)?

Answer 47

~36%

Question 48

Q: What is the paternity rate reported after nerve-sparing RPLND?

Answer 48

75%