Unilateral or Bilateral Retroperitoneal Lymph Node Dissection in Nonseminoma Patients with Postchemotherapy Residual Tumour? Results from RETROP, a Population-based Mapping Study by the Swedish Norwegian Testicular Cancer Group

Abstract

Background: The distribution of retroperitoneal lymph node metastases for patients with nonseminoma and a residual tumour of 10-49 mm in a population-based setting is unknown. This information is needed to justify selection of patients for a unilateral template resection. Objective: To describe the location of retroperitoneal metastases and recurrences in patients with nonseminoma germ cell tumour (NSGCT) with a residual tumour of 10-49 mm. Design, setting, and participants: RETROP is a population-based prospective observational mapping study of 213 patients in Sweden and Norway with a retroperitoneal residual tumour of 10-49 mm who underwent postchemotherapy retroperitoneal lymph node dissection for metastatic NSGCT during 2007-2014 with median follow-up of 100 mo. Patients were classified according to the testis primary tumour and the distribution of unilateral or bilateral lymph node metastases

Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours

“…Concerning pc-RPLND, as reliable prognostic markers for residual disease in RPLND specimens are still lacking, we are overtreating up to 40–50% of pc TGCT patients 16 . Thus the extent of the dissection and it’s morbidity should be as limited as possible 40 , 41 . This can be achieved with a robot-assisted approach and a limited dissection template 41 .…”

Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre

“…A nerve‐sparing unilateral resection is recommended in P‐RPLND. A detailed description of templates has been published by the SWENOTECA group previously 10 …”

New Landmarks Towards Reducing the Treatment Burden for Patients with a Postchemotherapy Residual Retroperitoneal Mass from Nonseminomatous Germ-cell Testicular Tumors

“…In this issue of European Urology Oncology, Gerdtsson et al [1] provide notable insights from a large population of patients and conclude that it is possible to identify patients eligible for postchemotherapy retroperitoneal lymph-node dissection (RPLND) for whom unilateral RPLND with guidance from prechemotherapy and postchemotherapy imaging is sufficient. This is one issue, and possibly one of the most important, towards de-escalation of the surgical burden in young patients undergoing chemotherapy for metastatic germ-cell tumors.…”

“…Gerdtsson et al [1] have carried out a meticulous mapping study of the extent of RPLND for postchemotherapy residual masses of 1-5 cm in size according to side and addressing the ability to remove pathologic deposits (cancer or teratoma).…”