Retroperitoneal staging lymphadenectomy in stage I nonseminomatous germ cell tumours of the testis

Abstract

The treatment of testicular germ cell tumours has been a constant interest to our department, comprising 268 cases over the last two decades. Alongside the spectacular progresses of specific, highly effective combination chemotherapy and retroperitoneal lymphnode surgery which have dramatically improved life expectancy and cancer free rates even in advanced abdominal or metastatic disease, the treatment and follow-up protocols for stage I nonseminomatous germ cell testicular tumours (NSGCTT) are still a question of debate. The option of "wait and see" or primary specific chemotherapy require a rigorous and wealthy healthcare system, i.e. important social costs; moreover, chemotherapy associates well-known toxic effects. These comments should also take into account the risk of CAT retroperitoneal understaging in these patients. Under this circumstances the authors propose the evaluation of the retroperitoneal lymphadenectomy (RPLA) in its modified fashion as the primary therapeutic approach in stage I NSGCTT, considering the accuracy of pathologic staging (chemotherapy becomes unnecessary) and the preservation of antegrade ejaculation (anejaculation being the major draw-back for the total bilateral RPLA). Another pro is its curative role in cases of occult abdominal disease. The main sequences of the modified RPLA are presented and commented, defining the rational ablation limits which assure a "nerve sparing" technique without oncologic rebate. in a precarious healthcare system, the modified RPLA might well be considered the primary option in the management of stage I NSGCTT for its oncologic staging and therapeutic merits, with low social costs and practically no morpho-functional sequelae.