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BackgroundThe prognostic value of the primary neoplasm responsible for pseudomyxoma peritonei (PMP) remains poorly studied. The aim of this study was to determine the prognosis for patients with extra-appendicular PMP (EA-PMP) treated optimally with complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsAll patients treated for PMP with CCRS and HIPEC between 1994 and 2016 were selected retrospectively from a French multicentre database. Patients with EA-PMP had pathologically confirmed non-neoplastic appendices and were matched in a 1 : 4 ratio with patients treated for appendicular PMP (A-PMP), based on a propensity score.ResultsSome 726 patients were identified, of which 61 (EA-PMP group) were matched with 244 patients (A-PMP group). The origins of primary tumours in the EA-PMP group included the ovary (45 patients), colon (4), urachus (4), small bowel (1), pancreas (1) and unknown (6). The median peritoneal carcinomatosis index was comparable in EA-PMP and A-PMP groups (15·5 versus 18 respectively; P = 0·315). In-hospital mortality (3 versus 2·9 per cent; P = 1·000) and major morbidity 26 versus 25·0 per cent; P = 0·869) were also similar between the two groups. Median follow-up was 66·9 months. The 5-year overall survival rate was 87·8 (95 per cent c.i. 83·2 to 92·5) per cent in the A-PMP group and 87 (77 to 96) per cent in the EA-PMP group. The 5-year disease-free survival rate was 66·0 (58·7 to 73·4) per cent and 70 (53 to 83) per cent respectively.ConclusionOverall and disease-free survival following treatment with CCRS and HIPEC is similar in patients with pseudomyxoma peritonei of appendicular or extra-appendicular origin.

Background Epithelioid peritoneal malignant mesothelioma (EPMM) is the most common subtype of this aggressive tumor. We compared two antibodies against PD-L1, a recent theranostic biomarker, and evaluated the prognostic value of PD-L1 expression by mesothelial and immune cells in EPMM. Methods Immunohistochemistry was performed on 45 EPMM. Clinical and pathological data were extracted from the RENAPE database. Using E1L3N and SP142 clones, inter-observer agreement, PD-L1 expression by mesothelial and immune cells and inter-antibody agreement were evaluated. The prognostic relevance of PD-L1 expression was evaluated in 39 EPMM by univariate and multivariate analysis of overall survival (OS) and progression-free survival (PFS). Results Inter-observer agreement on E1L3N immunostaining was moderate for mesothelial and immune cells, and fair for mesothelial and poor for immune cells using SP142. Using E1L3N, 31.1% of mesothelial and 15.6% of immune cells expressed PD-L1, and 22.2% of mesothelial and 26.7% of immune cells using SP142. Inter-antibody agreement was moderate. In most positive cases, 1–5% of tumor cells were positive. Using E1L3N, PD-L1 expression by lymphocytes was associated with better OS and PFS by both univariate and multivariate analysis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy predicted better prognosis than other treatments. Solid subtype was an independent prognostic factor for worse OS. Conclusion E1L3N appeared easier to use than SP142 to evaluate PD-L1 expression. A minority of EPMM expressed PD-L1, and only a few cells were positive. PD-L1 expression by immune cells evaluated with E1L3N was an independent prognostic factor in EPMM.

Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. Patients and methods: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). Results: All groups (NA: n Z 42; ADJ: n Z 16; PO: n Z 16; NoC: n Z 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P Z 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P Z 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07e4.94; P Z 0.033). Conclusion: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.

Background Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy. Objective To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC. Material and methods A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test. Results Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3–26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively. Conclusion Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

Objectif Le curage lombo-aortique est le traitement curatif chirurgical de reference des masses residuelles dans le cancer du testicule. Le curage doit comporter la totalite du tissu lymphatique au sein d’un volume precis. Les territoires de curage dependent de la localisation de la masse residuelle et les techniques chirurgicales ont ete revues pour diminuer la morbidite de cette intervention. Methodes Nous rapportons un cas de curage lombo-aortique radical modifie droit pour masse residuelle persistante apres chimiotherapie dans le cadre d’une tumeur testiculaire. Patient opere en 2018. Le territoire de curage presente comme limite superieure les veines renales, en limite laterale le pedicule spermatique droit, en limite mediale la face anterieure de l’aorte jusqu’a l’emergence de l’artere mesenterique inferieure, puis le bord droit de l’aorte jusqu’a sa bifurcation iliaque. La limite inferieure est la bifurcation iliaque interne/externe. L’intervention s’est deroulee par cœlioscopie avec abord extra peritoneal. Resultats Patient de 20 ans opere en juin 2018 d’un orchidectomie droite pour tumeur testiculaire. L’examen anatomo-pathologique rapportait une tumeur germinale non seminomateuse mixte associant du seminome, du carcinome embryonnaire et du carcinome vitellin. Le stade TNM etait pT1N2M0S2. A la fin de la chimiotherapie, le scanner de controle montrait la persistance d’une masse residuelle ganglionnaire inter aortico-cave de 11 × 10 mm. Apres discussion en RCP, indication de curage lombo-aortique radical modifie droit. Cette intervention s’est deroulee par voie laparoscopique avec abord extra peritoneal. Les suites operatoires ont ete simples. Le drain chirurgical retire au 4e jour post-operatoire. L’analyse histologique ne retrouvait pas de ganglion pathologique. Le scanner de controle realise a 2 mois post-operatoire ne retrouvait aucun signe evolutif de la pathologie. Conclusion Le curage lombo-aortique est une intervention chirurgicale avec une grande morbidite. Cette morbidite est due aux lesions realisees lors de l’intervention des fibres nerveuses sympathiques du plexus hypogastrique. Ces lesions sont responsables de troubles de l’ejaculation. Afin de minimiser ces lesions, des strategies d’epargne nerveuse comme le curage unilateral modifie ont ete developpees tout en etant oncologiquement valides.

Breast cancer is the most frequent female cancer with 48 800 new cases each year in France. A French national screening program in women without genetic risk factors has been initiated in 2004. Women with BRCA 1 or 2 mutations are included in surveillance programs. Women without such mutations can be assessed for breast cancer risk using risk prediction models. The aim of this study is to compare the performance of three breast cancer risk prediction models: GAIL2, BODICEA and IBIS in a population of patients (pts) who developed breast cancer. Patients and Methods: The GAIL1 model was performed to 188 pts at high risk of breast cancer according to their family history and who developed breast cancer. Personal and familial data was regenerated at the day before the diagnosis of breast cancer and the three models were applied. From this population, 60 pts were selected: for whom all information necessary to use the 3 models was available and for whom the GAIL1 model provided sufficient variability in the relative risk of breast cancer. The GAIL2 model takes into account individual risk factors: age, menarches, parity, age at first birth, history of breast biopsy, atypical hyperplasia or in situ lobular carcinoma. The BODICEA model considers age and familial risk factors: number of related affected by breast ovarian, prostate and pancreas cancer and age at diagnosis. Both personal and familial risk factors are used for the IBIS model. We estimated lifetime breast cancer risk for each patient with the three models from the available software packages. We assessed Pearson's correlation coefficient between the three models. Results Median (range) age was 45 years (25-74). Risk prediction could not be evalauted by the GAIL2 model for 14 pts since they were less than 35 years of age. Lifetime breast cancer risk was 16.1% (4.4-38.7) for GAIL2, 11.6% (2.2-39.5) for BODICEA and 16.5% (3.5-36.3) for IBIS. Pearson's correlation coefficient between BODICEA and GAIL2, IBIS and GAIL2 and between BODICEA and IBIS were 0.36, 0.38 and 0.69 respectively. In most cases, IBIS risk predictions were higher than GAIL2's which were higher than BODICEA's as soon as lifetime risk was at least 20%. When the three models were applicable (46pts), IBIS estimated a higher risk in 31 cases (67%) versus 10 for GAIL2 (21.74%) and 5 for BODICEA (10.86%). The median (range) time for use of the tools per patient was 30 seconds (16-80) for GAIL2, 588 (198-1804) for BODICEA and 86 (46-135) for IBIS. Discussion Results in this selected population of pts who developed breast cancer show that IBIS seems to be the better performer to predict breast cancer risk:. Results are obtained faster and the risk predictions provide higher estimates. The GAIL2 model is quick and easy to use but with a limited number of items. Conversely, BODICEA requires a very large number of items, not always available, and does not consider incomplete data. In conclusion, IBIS model seems to be the most suitable for practical use in the evaluation of breast cancer risk. Citation Format: Mailliez A, Kramar A, Peyrat J-P, Revillion F, Bonneterre J. Comparison of prediction models of breast cancer in high risk populations?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-16.

Background: Adjuvant chemotherapy (ACT) using anthracyclines and taxanes is a standard treatment for BC. Usual criteria as age, SBR grade, HER2 or hormonal status (HS), estrogen receptor (ER), triple negative BC, histological type, lymphovascular invasion (LVI), Ki67, tumor size and lymph node involvement are not yet sufficient for ACT decision. As SNPs located in genes involved in metabolism or transport of cytotoxic drugs may affect efficacy of ACT, we investigated the potential of 49 SNPs to predict response to ACT in BC. Methods: From 01/2008 to 01/2012, 418 patients (pts) with BC treated with ACT were included. 309 pts received FEC100-Docetaxel regimen (cohort 1), and 109 pts with HER2 overexpression FEC100-Docetaxel-Trastuzumab regimen (cohort 2). Genotyping of 49 SNPs was performed on germline DNA using real time PCR with SNPType (Fluidigm) or Taqman probes (Life technologies) on BioMark Platform (Fluidigm). PFS, MFS and overall survival (OS) were estimated by Kaplan-Meier method. Association of clinicopathologic features (CPF) with PFS/MFS was evaluated by log-Rank test. After ensuring Hardy-Weinberg equilibrium was respected, PFS/MFS were correlated to CPF and genotypes, using univariate and multivariate Cox logistic regression. A prognostic score was established. Results: PFS, MFS and OS rates were respectively 81.8%, 83.4% and 87.3% in cohort 1 (3.4 years of median follow up (FU)) and 90.1%, 90% and 93.8% in cohort 2 (4 years of FU). In cohort 1, univariate analysis revealed that 5 SNPs, SLCO1B3 (rs11045585), NOS3 (rs1799983), CYB2B6 (rs2279345), BRCA1 (rs799917) and CYP2D6 (rs3892097) were associated with MFS. Genotypes, HR, 95%CI and p value are as follows: SLCO1B3 GG 7.73 (1.83-32.7) p=0.001, NOS3 GT 0.32 (0.14-0.76) p=0.006, CYB2B6 TT 2.29 (1.02-5.13) p=0.04, BRCA1 CT 0.41 (0.19-0.89) p=0.02, and CYP2D6 AG 2.14 (1.05-4.36) p=0.03. Multivariate analysis revealed that 4 SNPs remained associated with metastatic risk: CYB2B6; TT 2.38 (1.05-5.41) p=0.038, NOS3; GG-TT 3.11 (1.33-7.27) p=0.009, BRCA1; CC-TT 2.21 (1.01-4.85) p=0.047, CYP2D6; AG 2.14(1.04-4.40) p=0.039. No CPF was associated with survival. Prognostic model revealed a metastatic risk of 10.25 (1.29-81.31) if these four adverse genotypes coexist. In cohort 2, subject to limited number of events, age (p=0.03), HS (p=0.06), ER (p=0.05), LVI (p=0.02) tumor size (p=0.003) and 2 SNPs were associated in univariate with PFS: CYB2B6 (rs2279345); CT 5.73 (1.22-27) p=0.01, MTHFR (rs1801133); CT 4.61 (0.98-21.7) p=0.03. Multivariate analysis showed unfavorable PFS for heterozygous patients for CYB2B6 or for MTHFR: 9.67 (1.82-51.28) p=0.008 and 5.62(1.19-26.59) p=0.03 respectively and if tumor size was ≥T2 10.78 (2.12-54.90) p=0.004. Conclusion: SNPs of genes involved in oxidative stress (NOS3 rs1799983; GG-TT), docetaxel transport (SLCO1B3 rs11045585; GG) cyclophosphamide (CYB2B6 rs2279345; TT in cohort 1 ou CT in cohort 2) and 5FU metabolism (MTHFR rs1801133; CT), or DNA repair (BRCA1rs799917; CC-TT) are associated with survival in pts treated with ACT. BRCA1, CYB2B6 and SLCO1B3 represent potential attractive tools for guiding ACT indication. Citation Format: Ducoulombier A, Dumont A, Revillion F, Bonneterre J, Peyrat J-P. Evaluation of single nucleotide polymorphisms (SNPs) as predictive factors of progression (PFS) and metastatic (MFS) free survival in adjuvant breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-24.

CONTEXT AND AIMS:Breast cancer prognosis and predictive biomarkers development would allow sparing some patients from chemotherapy or identifying patients for whom chemotherapy would be indicated. In this context, in 2009, the French National Cancer Institute, a National Health and Science Agency dedicated to cancer, in collaboration with the French society of senology and breast pathology (SFSPM) published a report on the assessment of the prognostic and the predictive clinical validity of tissular biomarkers, uPA/PAI-1, Oncotype DX™ and MammaPrint(®), in breast cancer management. They concluded that only the uPA/PAI-1 prognosis value reached the highest level of evidence (LOE I according to Hayes 1998 classification). In 2012, it was decided to update this report since new data have emerged and because information disparities among clinicians have been identified. This article aims to present the main conclusions together with the levels of evidence associated with those conclusions.METHODS:The updating process was based on literature published since 2009 appraisal and on multidisciplinary and independent experts' opinion. The levels of evidence (LOE) used are those of the classification defined by Simon in 2009 (updated Hayes 1998 classification): LOE IA and LOE IB: high level of evidence; LOE IIB and LOE IIC: intermediate level of evidence; LOE IIIC and LOE IV-VD: low level of evidence.CONCLUSIONS:Among patients without lymph-node involvement, uPA/PAI-1, invasion process biomarkers, reach the highest level of evidence for 10 years recurrence free survival prognosis (LOE IA according to Simon). The predictive value to anthracyclins chemotherapy remains to be confirmed. Oncotype DX™ and MammaPrint(®) prognosis and predictive value do not reach the LOE I level. This updating' process confirms the 2009 levels of evidence for all the three biomarkers prognosis value. Besides, concerning Oncotype DX™ and MammaPrint(®), new data do not allow to conclude neither to their complementary clinical information to other clinicopathological existing biomarkers nor to a favorable cost-efficiency ratio in therapeutic decision making and this because of the methodological weakness and uncertainty that are identified in the selected studies. Practically, beyond the prognosis and predictive biomarkers validity, the clinical utility of a new biomarker for chemotherapy indication depends on its clinical added information with regard to validated biomarkers (HR, HER2 and Ki67) and to clinicopathological parameters. Since they are the sole validated biomarkers of the invasion process, uPA/PAI-1 could complete clinical information of other clinicopathological factors and consequently could confer an added clinical value. However, data concerning the impact of this information on chemotherapy clinical indication are lacking.Copyright © 2014. Published by Elsevier Masson SAS., IntroductionDans le cancer du sein, le développement des marqueurs biologiques pronostiques ou prédictifs a pour objectif de mieux identifier les patientes pour lesquelles un traitement par chimiothérapie pourrait être évité ou a contrario indiqué. Dans ce contexte, en 2009, l’Institut national du cancer (INCa), agence sanitaire et scientifique de l’État chargée de coordonner les actions de lutte contre le cancer, avait publié en partenariat avec la Société française de sénologie et de pathologie mammaire un rapport sur l’état des connaissances relatives aux biomarqueurs uPA/PAI-1, Oncotype DX™ et MammaPrint® dans la prise en charge du cancer du sein. Ce rapport avait montré que seule la valeur pronostique d’uPA/PAI-1 atteignait le plus haut niveau de preuve (LOE I selon la grille de Hayes 1998). En 2012, devant la parution de nouvelles publications et la divergence des messages diffusés sur les signatures moléculaires, il a été décidé d’actualiser le rapport de 2009. Cet article présente les principales conclusions accompagnées de leurs niveaux de preuve.MéthodeLe processus de mise à jour s’est appuyé sur l’analyse des données publiées depuis la recherche bibliographique de 2009, complétée par l’avis d’un groupe de travail multidisciplinaire indépendant. Les niveaux de preuve employés sont ceux de la classification définie par Simon en 2009 (grille de Hayes 1998 après mise à jour) : LOE IA et LOE IB : niveau de preuve élevé ; LOE IIB and LOE IIC : niveau de preuve intermédiaire ; LOE IIIC and LOE IV-VD : niveau de preuve faible.ConclusionsChez les patientes sans envahissement ganglionnaire (pN0), uPA/PAI-1, marqueurs d’invasion, ont un niveau de preuve élevé (LOE IA selon Simon) pour la valeur pronostique de la survie sans récidive à 10 ans. Il reste à confirmer leur valeur prédictive de réponse aux anthracyclines. Pour Oncotype DX™ et MammaPrint®, les valeurs pronostique et prédictive n’ont pas atteint à ce jour le niveau de preuve LOE I. Ce travail confirme les niveaux de preuve précédemment établis dans le rapport de 2009. Par ailleurs, les données ne permettent pas de conclure à une valeur ajoutée de Oncotype DX™ et MammaPrint® par rapport aux outils existants. Les données médico-économiques ne permettent pas de statuer sur le rapport coût/efficacité des stratégies utilisant ces tests dans la décision thérapeutique compte tenu d’un niveau de qualité insuffisant pour la plupart des études et d’une forte incertitude mise en évidence par les quelques études bien menées. En pratique, au-delà des niveaux de preuve attribuables à la valeur pronostique et prédictive d’un biomarqueur, l’utilité clinique d’un nouveau marqueur dans l’aide à la prescription d’une chimiothérapie repose sur sa valeur ajoutée par rapport aux marqueurs validés (RH, HER2 et les marqueurs de prolifération comme Ki67) et aux critères anatomo-cliniques. Puisqu’ils sont les seuls marqueurs validés à témoigner du processus d’invasion, uPA/PAI-1 peuvent apporter une information complémentaire et donc avoir une valeur ajoutée par rapport aux marqueurs existants. Les données de la littérature manquent pour apprécier le poids de cette valeur ajoutée dans la décision de prescrire ou non une chimiothérapie.

Background Retroperitoneal nodal metastases (RNM) represent 1–2% of metastases from colorectal cancer (CRC). Non-surgical treatments achieve 5-year overall survival (OS) of 0–12%. Radical retroperitoneal lymphadenectomy (RRL) in this setting remains controversial, but most published series do not distinguish local retroperitoneal recurrences from RNM. We specifically report outcomes after RRL for RNM from CRC. Methods We analyzed prospectively recorded data from patients who underwent standardized RRL for RNM from CRC between January 1997 and August 2012 in our institution. Local retroperitoneal recurrences were excluded. Results Twenty-five patients underwent RRL for synchronous (n = 19) or metachronous (n = 6) RNM from CRC. Fifteen patients had extra-retroperitoneal metastases. Median hospital stay was 16 [7–23] days. Grade ≥ III morbidity was 8% with no perioperative deaths. Median follow-up was 85 [4–142] months. Median OS and progression free survival (PFS) were 60 [4–142] and 14 [1–116] months. One, three- and 5-year OS were 92%, 64% and 47%. One, three- and 5-year PFS were 51%, 26% and 26%. Retroperitoneal nodal metastases from stage III CRC were associated with better median OS compared to those from stage IV CRC (p = 0.02). This variable did not impact on PFS. Subject to substantial risk of type II error on small samples data statistical analysis, survivals were not affected by timing and location of RNM, extra-retroperitoneal metastasis, nodal disruption, neoadjuvant nor adjuvant chemotherapy. Conclusions To our knowledge, this is the largest series yet reported which specifically studied outcomes of RRL for RNM from CRC. RRL allows favorable outcomes in selected patients with acceptable morbidity.

Introduction Peritoneal metastasis (PM) of hepatocellular carcinoma (HCC) without distant spread are rare. The related prognosis is poor without standard treatment available. The role of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is poorly documented. Methods An international multicentric cohort was constituted by retrospective analysis of 21 patients undergoing CRS/HIPEC for PM of HCC between 1992 and 2016 from 10 reference centers of PSOGI. Data on clinical features, treatment strategies, and survival outcomes were analyzed. Results The median time interval from the diagnosis of PM to the procedure was 4.5 months. The median peritoneal cancer index was 14. Sixteen patients had complete cytoreduction (CCR0-1). Ten patients had grades 3 to 4 complications. The median duration of follow-up was 52.2 months. The median OS was 46.7 months. The projected 3y-OS and 5y-OS were 88.9 and 49.4% respectively. The median OS for patients with CCR0-1 resection was not reached whereas it was 5.9 months for those with CCR2-3 resection after CRS (p = 0.0005). The median RFS was 26.3 months and projected RFS at 3 years of 36.5 months Three prognostic factors were associated with improved RFS in the univariate analysis: preoperative chemotherapy (p = 0.0156), PCI >15 (p = 0.009), Number of chemotherapy agents used for HIPEC (p = 0.005). Conclusion CRS/HIPEC is a safe and effective approach in selected patients with PM of HCC. CRS/HIPEC gives the patient a chance for a good relapse free and overall survival and should be considered as an option.

Objectif Dans les tumeurs germinales non seminomateuses du testicule (TGNS), la chirurgie des masses ganglionnaires residuelles apres chimiotherapie est necessaire, en cas de masses superieures a 1 cm. Le curage ganglionnaire lombo-aortique bilateral complet est recommande, mais un curage unilateral modifie peut etre propose pour des masses residuelles de faibles volumes, dans une strategie d’epargne nerveuse, afin de limiter les troubles de l’ejaculation. Methodes Cette video illustre le cas d’un homme de 38 ans presentant une TGNS du testicule droit, classee pT2N2M0S1, de bon pronostic, avec une adenopathie inter aortico-cave de 25 mm. Il a eu une chimiotherapie par 3 cures de BEP (Bleomycine, Etoposide et Cisplatine). Les marqueurs tumoraux se sont normalises apres 2 cures de BEP. Le scanner de reevaluation met en evidence la persistance d’une adenopathie inter aortico-cave de 14 mm. Le patient a ete opere d’un curage ganglionnaire unilateral modifie droit. Resultats Installation en decubitus dorsal. Une laparotomie mediane xypho-pubienne est pratiquee. On expose l’espace retro-peritoneal en decollant la racine du mesentere. On repere les limites du curage : uretere droit (laterale), pedicules renaux (superieure), bifurcation iliaque (inferieure), ligament commun vertebral posterieur (posterieure). On retire tous les elements ganglionnaires latero-cave, pre-cave, retro-cave et inter aortico-cave, de la bifurcation iliaque aux veines renales. On retire les tissus lymphatiques pre-aortiques, uniquement dans le territoire au-dessus de l’artere mesenterique superieure, jusqu’aux pedicules renaux, en preservant l’adventice arteriel. On reseque en totalite le pedicule spermatique droit, jusqu’a l’orifice inguinal profond. Les suites ont ete simples, le patient sort a J3 apres ablation du drain. L’analyse histologique a mis en evidence du teratome au niveau de la masse inter aortico-cave. Conclusion Un curage unilateral modifie peut-etre propose pour diminuer la morbidite post-operatoire. L’interet de cette video est de presenter anatomiquement les limites du curage et la conservation de l’adventice arteriel, afin de preserver les fibres nerveuses du plexus hypogastrique.