Nerve-sparing technique in RPLND for testicular cancer

Abstract

Purpose of reviewThe management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. Recent findingsThe standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. SummaryRPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.

Testicular Cancer Treatments and Sexuality: A Narrative Review

“…In addition, Matos et al stated that non-nerve-sparing techniques showed important issues of fertility [114][115][116]. Another important issue regarding surgery is erectile dysfunction; contrary to what can be hypothesized, Dimitropoulos et al showed that in 53 patients, no difference in erectile functioning before and after operation was found [5].…”