Abstract:
The standard primary therapeutic approach recommended in stage II nonseminomatous germ
cell testicular tumours (NSGCTT) in current practice is specific, aggressive chemotherapy. Retroperitoneal lymphadenectomy (RPLA) is a second line therapy, being currently restricted to those
patients who present with residual abdominal mass after chemo regimens.
The authorsâ experience comprises 12 total RPLA for stage II NSGCTT in the last 4 years: 4 primary
RPLA and 8 secondary RPLA (preceded by ВЕР cycles). The main sequence of the operative technique of primary total RPLA for stage II disease is presented.
Access was gained through a midline abdominal incision. Teratoma was present in the primary
pathologic specimen in half of the cases. In such cases we consider the primary total RPLA as the
first option, being aware of the inefficacy of combination chemotherapy on teratoma and the risk
of hazardous, seriated, even incomplete surgical resections in advancing abdominal disease. In
two of three cases the operative pathologic staging corrected the preoperative CAT staging! There
were no intra or postoperative complications. Adjuvant specific chemotherapy (2 ВЕР cycles) was
delivered as a routine, this strategy granting curability in all cases.
Conclusively, the authors propose a revaluation of the primary total RPLA in the therapeutic approach of NSGCTT stage II minimal or moderate abdominal disease, considering the operation as
complete and easier to perform than in postchemo local conditions. This is especially valid in case
of teratoma in the primary tumor, as teratomatous elements in the retroperitoneum will respond only
to surgery. Moreover, the chemotherapeutic effort is reduced, more efficient, with lower toxic side
effects. Under current conditions, this approach grants high cure rates with low medical and social
costs.
