Retroperitoneal Lymphadenectomy for Testis Tumor with Nerve Sparing for Ejaculation

Abstract

The principal morbidity of retroperitoneal lymphadenectomy is the potential loss of ejaculation and, therefore, fertility owing to damage of the retroperitoneal sympathetic nerves that form the superior hypogastric plexus. We describe the results of our retroperitoneal lymphadenectomy when individual nerves from the sympathetic ganglia are identified and preserved while still performing a thorough bilateral retroperitoneal lymphadenectomy. The nerve-sparing procedure was technically feasible in 20 of 30 consecutive patients and it was only impractical with extensive gross disease. Of the 20 patients 18 (90 per cent) ejaculate, including 8 with bulky (5 cm. or more) residual retroperitoneal disease who underwent a successful nerve-sparing operation. All 12 patients (100 per cent) with nonbulky disease ejaculate. With short followup, no retroperitoneal recurrences have been detected. This technique is an alternative to limited dissection designed to spare nerves using boundaries based on the patterns of metastatic involvement.

The Total Number of Retroperitoneal Lymph Nodes Resected Impacts Clinical Outcome Following Chemotherapy for Metastatic Testicular Cancer

“…11 Furthermore, with nerve-sparring techniques, antegrade ejaculation is preserved in a similar proportion of men undergoing a bilateral RPLND. 15,16 Additionally, modified template dissections limit anatomic regions of dissection and thus may be associated with a reduced number of lymph nodes resected by the surgeon and analyzed by the pathologist. Therefore, limiting the anatomic regions of a PC-RPLND may be associated with a higher risk of recurrence and a lower accuracy of histologic classification and pathologic staging.…”

How safe is surveillance in patients with histologically low-risk non-seminomatous testicular cancer in a geographically extended country with limited computerised tomographic resources?

“…Nerve-sparing RLND (Jewett et al, 1988;Donohue et al, 1993) is a reasonable alternative to surveillance and does not usually lead to long-lasting sequelae. The operation represents, however, major surgery with 6-8 weeks' sick leave in most patients.…”

Current Concepts in Management of Stage I NSGCT

“…Subsequent RP relapse is rare, and abdominal imaging can be restricted to one baseline CT a few months after surgery. With the introduction of nerve-sparing technique along with various modified templates, antegrade ejaculation rates of 90-100% have been reported, with significantly reduced morbidity and virtually unknown mortality [64][65][66]. It is important to be aware of slowgrowing retroperitoneal teratomas after primary chemotherapy [67].…”