Retroperitoneal lymph node dissection after chemotherapy for germ cell tumours: is a full bilateral template always necessary?
OBJECTIVE
To evaluate the long-term oncological outcome in selected patients treated for nonseminomatous germ cell tumours (NSGCT) with a retroperitoneal lymph node dissection after chemotherapy (pcRPLND) and not using the full bilateral template.


METHODS
From 1988 to 2005, 102 patients with retroperitoneal stage II NSGCT, who at initial presentation had metastases in the primary retroperitoneal site only, had pcRPLND within a restricted template, whether computed tomography showed complete or incomplete remission. In all, 78 patients had a unilateral template dissection and 24 an open modified template dissection.


RESULTS
Of the 102 patients, 30 had stage IIC, 63 IIB, and nine tumour marker-positive stage IIA disease. Active tumour was found in two RPLND specimens; mature teratoma in 46 of the 102 patients, and necrosis/fibrosis in 54. Antegrade ejaculation was preserved in all 78 patients who had unilateral RPLND and in 18 of 24 who had a modified RPLND (overall antegrade ejaculation rate 94%). During a median follow-up of 102 months there were only three recurrences, two outside the retroperitoneum and one in the retroperitoneum. Only the latter was retrocaval, above the level of the inferior mesenteric artery within the boundaries of a full bilateral RPLND. This patient had had left unilateral template dissection after chemotherapy for IIC disease which was restricted to the para-aortic nodes.


CONCLUSIONS
In a selected group of patients with stage II NSGCT, pcRPLND within the modified template might be oncologically efficient and allow ejaculation to be preserved.
Steiner
Hannes
H
Department of Urology, Medical University Innsbruck, Austria. hannes.steiner@uki.at
Peschel
Reinhard
R
Bartsch
Georg
G
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D004542:Ejaculation; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards*; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000556:secondary*; D013736:Testicular Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome