Current Status of Retroperitoneal Lymph Node Dissection and Testicular Cancer: When to Operate

Richard Foster, MD; Richard Bihrle, MD

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Abstract and Introduction

Abstract

Background: Historically, retroperitoneal lymph node dissection (RPLND) has been used in the therapy of both low-stage and high-stage testicular cancer after chemotherapy. As other therapies have developed, the role of RPLND has also evolved.
Methods: The authors review the current indications for RPLND in the therapy of testicular cancer.
Results: Metastatic testicular cancer can be cured in 50% to 75% of cases by surgical removal using RPLND, depending on the volume of metastasis. In postchemotherapy disease, the surgical removal of teratoma or carcinoma also confers a therapeutic benefit to the patient.
Conclusions: The therapeutic capability of RPLND in low-stage testicular cancer is underappreciated. In postchemotherapy disease, this therapeutic capability is retained if the patient has carcinoma or teratoma in the metastatic tumor. In postchemotherapy disease, efforts continue to appropriately select patients preoperatively who have only fibrosis and necrosis in the specimen and therefore do not derive therapeutic benefit from RPLND.

Introduction

It is well recognized that cisplatin-based chemotherapy is highly effective in the treatment of metastatic testicular cancer. Indeed, the development of cisplatin-based chemotherapy was one of the great success stories in the treatment of metastatic cancer.[1] Clearly, testicular cancer is one of the most chemosensitive tumors.

Metastatic testis cancer is also highly amenable to curative surgical therapy. Most cancers are, in fact, systemic when spread to a lymph node is noted and verified. Therefore, the removal of involved lymph nodes is not curative in most cancers as the majority of these patients have distant micrometastatic disease. Testicular cancer is different in this regard. The spread of testis cancer is by and large predictable and sequential; hence, the surgical removal of metastatic tumor is curative 30% to 75% of the time depending on the clinical situation, site of metastasis, and volume of metastatic disease.[2]

Testis cancer is not only one of the most chemosensitive tumors, but also one of the most "surgery-sensitive" tumors. This review discusses the indications and outcome of retroperitoneal lymph node dissection (RPLND) in the therapy of testis cancer, and it enumerates the indications for surgical therapy on a stage-by-stage basis. The discussion of surgical therapy is relevant for nonseminomatous disease; the few indications for surgery in metastatic seminoma are discussed separately.

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