title: Post-chemotherapy nerve-sparing retroperitoneal lymph node dissection for advanced germ cell tumor.
abstract: OBJECTIVE
  To report our experience with post-chemotherapy nerve-sparing retroperitoneal lymph node dissection (RPLND) for advanced germ cell tumor (GCT).
  
  
  METHODS
  Between 1994 and 2008, 92 patients with advanced GCT underwent RPLND after multiple treatments with systemic chemotherapy at our institution. A nerve-sparing RPLND was carried out in 78 patients (84.8%; median age 32 years). Of them, 19 had a seminoma and 59 had a non-seminoma.
  
  
  RESULTS
  Lumbar splanchnic nerves controlling ejaculatory function were macroscopically preserved during RPLND. Bilateral and unilateral lumbar splanchnic nerves were preserved in 40 patients and 38 patients, respectively. Sixty-five patients could be evaluated for ejaculation. Fifty-four patients (83.1%) achieved antegrade ejaculation with a median postoperative interval of 3 months (range: 1-10 months). Twenty-eight patients (28/30: 93.3%) and 26 patients (26/35: 74.3%) undergoing bilateral and unilateral nerve-sparing RPLND had antegrade ejaculation, respectively (P = 0.041). Only two patients (2.6%) had mediastinal and retroperitoneal recurrences during a median follow-up of 42 months (range: 1-138 months), respectively. However, these patients were cured by chemotherapy and surgery.
  
  
  CONCLUSIONS
  Post-chemotherapy nerve-sparing RPLND preserves ejaculatory function in the majority of patients with advanced GCT without increasing the risk of local recurrence.
authors.affiliation: Department of Urology, Kyoto Prefectural University of Medicine, Kamigyo-Ku, Kyoto, Japan. tmiki@koto.kpu-m.ac.jp
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Mizutani
authors.forename: Terukazu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kawauchi
authors.forename: Akira
authors.initials: A
authors.lastname: Nagahara
authors.forename: Norio
authors.initials: N
authors.lastname: Nonomura
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okuyama
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult