Nerve-sparing retroperitoneal lymphadenectomy for low stage testicular cancer.
In order to maintain antegrade ejaculation after retroperitoneal lymphadenectomy (RLND) for low stage non-seminomatous germ cell cancer, we implemented a nerve-sparing technique in which the sympathetic nerves were preserved. Thirty-eight patients were clinically staged: 27 were stage I and 11 were either IIa or IIb. Laparotomy revealed that in 2 patients the nerve-sparing technique was not feasible. Fifteen patients had lymph node metastases at frozen section examination and underwent a bilateral nerve-sparing RLND. In the remaining 21 patients the procedure was unilateral. Clinical understaging occurred in 26% of patients (10/38) and overstaging in 8% (3/38). Patients with lymph node metastases received 2 cycles of adjuvant chemotherapy. Mean follow-up was 17 months. Antegrade ejaculation was preserved after bilateral and unilateral nerve-sparing RLND in 86% (12/14) and 95% (19/20) respectively. No recurrences were seen and so far the good prognosis of these patients has not been affected by this new technique.
Department of Urology, University Hospital, Nijmegen, The Netherlands.
M J
MJ
de Bruin
G O
GO
Oosterhof
F M
FM
Debruyne
D000293:Adolescent; D000328:Adult; D004542:Ejaculation; D005500:Follow-Up Studies; D006801:Humans; D007248:Infertility, Male / Q000517:prevention & control*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D012187:Retroperitoneal Space; D013564:Sympathetic Nervous System; D013736:Testicular Neoplasms / Q000473:pathology*