title: Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma.
abstract: BACKGROUND
  The long-term morbidity associated with treating advanced seminoma can be significant. Retroperitoneal lymph node dissection (RPLND) has established oncologic efficacy in treating germ cell tumors with minimal long-term toxicity. We describe our experience with RPLND as a front-line treatment of lymph node-positive seminoma.
  
  
  METHODS
  We reviewed our institutional review board-approved testicular cancer database to find the patients with pure seminoma and isolated retroperitoneal lymph node disease who had undergone primary RPLND. The clinical and pathologic variables were obtained. The follow-up data were used to determine recurrence and death.
  
  
  RESULTS
  Four patients with a mean age of 37 years were identified. All patients had normal tumor markers and retroperitoneal lymphadenopathy measuring 1.1, 1.5, 1.8, and 5.5 cm before RPLND. Of the 4 patients, 3 had had seminoma diagnosed at orchiectomy and 1 (with a 5.5-cm retroperitoneal lymphadenopathy and a burned out primary testicular mass) had had seminoma diagnosed at RPLND after 2 nondiagnostic retroperitoneal biopsies. All patients had undergone nerve-sparing, template, extraperitoneal RPLND and were discharged home after 3 days. An average of 3 positive lymph nodes were found. Of the 4 patients, 3 had pathologic stage IIA and 1 stage IIB disease, with no patient undergoing adjuvant therapy. At a mean follow-up period of 25 months, no patient had experienced disease recurrence, and none had died. All patients maintained antegrade ejaculation, and no long-term complications had developed.
  
  
  CONCLUSIONS
  Our small series has demonstrated encouraging oncologic efficacy for RPLND as a primary treatment of retroperitoneal lymph node-positive seminoma. A multi-institutional phase II trial of RPLND for stage IIA seminoma is being developed.
authors: Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors: Brian
authors: B
authors: Hu
authors: Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors: Swar
authors: S
authors: Shah
authors: Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors: Sepehr
authors: S
authors: Shojaei
authors: Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: daneshma@med.usc.edu.
authors: Siamak
authors: S
authors: Daneshmand
mesh_terms: D000328:Adult; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008297:Male; D012187:Retroperitoneal Space / Q000601:surgery; D018239:Seminoma / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Morbidity; Recurrence; Retroperitoneal lymph node dissection; Seminoma; Testicular cancer