Nerve-sparing retroperitoneal lymphadenectomy.
Surgery for retroperitoneal nodal metastases of testicular germ-cell tumors has evolved considerably since its inception. Minimizing injury to sympathetic nerves has involved their exclusion from resection boundaries and/or "nerve sparing," by identifying and preserving nerves within the resection field. These measures improve long-term procedure-related morbidity with equivalent rates of cancer control. We believe that nerve-sparing techniques are the standard of care and enforce good principles of surgery by demanding attention to anatomy and exposure. Experience with this procedure, knowledge of retroperitoneal anatomy, and thoughtful clinical and surgical decision making are imperative to achieving acceptable results. It behooves urologic oncologists to offer patients maximal therapeutic benefit combined with minimal morbidity and that retroperitoneal lymphadenectomy should be nerve sparing by definition.
Jewett
Michael A S
MA
Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital and the University Health Network, Toronto, ON, Canada. m.jewett@utoronto.ca
Groll
Ryan J
RJ
D000320:Adrenergic Fibers; D004542:Ejaculation / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D013737:Testis / Q000294:innervation*; D016896:Treatment Outcome