Distribution of Nodal Metastases in Nonseminomatous Testis Cancer

No AccessJournal of Urology1 Aug 1982Distribution of Nodal Metastases in Nonseminomatous Testis Cancer John P. Donohue, James M. Zachary, and Barney R. Maynard John P. DonohueJohn P. Donohue , James M. ZacharyJames M. Zachary , and Barney R. MaynardBarney R. Maynard View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)52904-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The distribution of 104 consecutive stage II (or B) nonseminomatous germinal cell testis tumor deposits in the retroperitoneal space has been analyzed and segregated into 11 anatomic zones of spread: 1) right para-caval, 2) right pre-caval, 3) inter aortocaval, 4) left pre-aortic, 5) left paraaortic, 6) right (renal) suprahilar, 7) left suprahilar, 8) right iliac, 9) left iliac, 10) inter iliac (pre-lumbosacral) and 11) gonadal vein. Each patient had no treatment after orchiectomy and before retroperitoneal lymph node dissection, that is no preoperative radiotherapy or chemotherapy, which may have influenced histologic analysis. Each patient had an extended bilateral retroperitoneal lymph node dissection, including both suprahilar zones. Tumor deposits in these 11 nodal zones were correlated with the side of the primary lesion (right versus left side) and the extent of metastatic disease (B1, B2 or B3). The inter aortocaval zone, just below the left renal vein, is the most common site of tumor deposition (93 per cent) of right testis tumors (primary right side). The pre-aortic (88 per cent) and left para-aortic (86 per cent) areas are the most common sites of left testis tumor nodal spread (primary left side). The right and left suprahilar zones are involved rarely in low stage (B1) disease. No suprahilar nodes were positive in stage B1 disease if the primary was on the right side and only 3 of 14 were positive with B1 disease on the left side. However, in stage B2 disease the suprahilar zones were involved more often with tumor (13 to 33 per cent if the primary was on the right side and 16 to 42 per cent if the primary was on the left side). There is a positive correlation between extent of disease and involvement of suprahilar nodes. A significant number of gonadal veins and their lymphatics are involved with tumor (14 to 17 per cent), even in low stage disease (8 to 14 per cent). The ipsilateral iliac areas rarely are involved with tumor in low stage disease (0 to 14 per cent), and contralateral iliac involvement is a rarity (1 of 40). Also, contralateral (right para-caval if the primary is on the left side or left para-aortic if the primary is on the right side) nodes were negative in low stage disease but commonly positive in B2 disease, especially when the primary was on the right side. The lymphatic drainage of the testis follows predictable and preferential pathways. This clinical study confirms earlier lymphangiographic studies here and abroad, suggesting abundant crossover and subsequent suprahilar drainage. However, suprahilar nodes are so rarely involved in low stage (B1) disease that dissection in this area is unnecessary in routine staging retroperitoneal lymphadenectomy. © 1982 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByDouglawi A, Calaway A, Tachibana I, Panizzutti Barboza M, Speir R, Masterson T, Adra N, Foster R, Einhorn L and Cary C (2020) Long-Term Oncologic Outcomes after Primary Retroperitoneal Lymph Node Dissection: Minimizing the Need for Adjuvant ChemotherapyJournal of Urology, VOL. 204, NO. 1, (96-103), Online publication date: 1-Jul-2020.Russell C, Espiritu P, Kassouf W, Schwaab T, Buethe D, Dhilon J, Sexton W, Poch M, Powsang J, Tanguay S, Nayan M, Alsaadi H, Hanzly M and Spiess P (2014) Surgical Outcomes in the Management of Isolated Nodal Recurrences: A Multicenter, International Retrospective CohortJournal of Urology, VOL. 192, NO. 2, (350-356), Online publication date: 1-Aug-2014.Pedrosa J, Masterson T, 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METASTATIC YOLK SAC TUMOR OF THE CORPUS CAVERNOSUM OF THE PENISJournal of Urology, VOL. 160, NO. 3 Part 1, (833-834), Online publication date: 1-Sep-1998.EINHORN L and DONOHUE J (2018) ADVANCED TESTICULAR CANCER: UPDATE FOR UROLOGISTSJournal of Urology, VOL. 160, NO. 6 Part 1, (1964-1969), Online publication date: 1-Dec-1998.Van Basten J, Jonker-Pool G, Van Driel M, Sleijfer D, Droste J, Van De Wiel H, Koops H, Molenaar W and Hoekstra H (2018) SEXUAL FUNCTIONING AFTER MULTIMODALITY TREATMENT FOR DISSEMINATED NONSEMINOMATOUS TESTICULAR GERM CELL TUMORJournal of Urology, VOL. 158, NO. 4, (1411-1416), Online publication date: 1-Oct-1997.Nash P and Donohue J (2018) Discordance Between Site of Primary Nonseminomatous Germ Cell Tumor of the Testis and Retroperitoneal Metastatic Disease Secondary to Anomalous Venous Drainage of the TestisJournal of Urology, VOL. 155, NO. 4, (1393-1394), Online publication date: 1-Apr-1996.Coogan C, Hejase M, Wahle G, Foster R, Rowland R, Bihrle R and Donohue J (2018) Nerve Sparing Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Advanced Testicular CancerJournal of Urology, VOL. 156, NO. 5, (1656-1658), Online publication date: 1-Nov-1996.Leibovitch I, Foster R, Kopecky K and Donohue J (2018) Improved Accuracy of Computerized Tomography Based Clinical Staging in Low Stage Nonseminomatous Germ Cell Cancer Using Size Criteria of Retroperitoneal Lymph NodesJournal of Urology, VOL. 154, NO. 5, (1759-1763), Online publication date: 1-Nov-1995.Baniel J, Foster R, Einhorn L and Donohue J (2018) Late Relapse of Clinical Stage I Testicular CancerJournal of Urology, VOL. 154, NO. 4, (1370-1372), Online publication date: 1-Oct-1995.Richie J (2018) Editorial CommentJournal of Urology, VOL. 152, NO. 2 Part 1, (430-430), Online publication date: 1-Aug-1994.Wahle G, Foster R, Bihrle R, Rowland R, Bennett R and Donohue J (2018) Nerve Sparing Retroperitoneal Lymphadenectomy After Primary Chemotherapy for Metastatic Testicular CarcinomaJournal of 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131, NO. 2, (343-343), Online publication date: 1-Feb-1984.Lange P, Narayan P, Vogelzang N, Shafer R, Kennedy B and Fraley E (2018) Return of Fertility After Treatment for Nonseminomatous Testicular Cancer: Changing ConceptsJournal of Urology, VOL. 129, NO. 6, (1131-1135), Online publication date: 1-Jun-1983.Kamer M, Rowland R, Einhorn L and Donohue J (2018) Recurrent Testis Cancer: Seeding from Retroperitoneal Nodes after Complete Remissions by ChemotherapyJournal of Urology, VOL. 130, NO. 6, (1196-1198), Online publication date: 1-Dec-1983. Volume 128Issue 2August 1982Page: 315-320 Advertisement Copyright & Permissions© 1982 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Donohue More articles by this author James M. Zachary More articles by this author Barney R. Maynard More articles by this author Expand All Advertisement Loading ...