Onkológia 6/2012

Retroperitonal lymph node dissection after primary chemotherapy for advanced testicular cancer

Retroperitoneal lymph node dissection (RPLND) of residual tumorous mass after induction chemotherapy plays important role in managing patients with advanced germ cell testicular tumors. Current CT criteria alone are not sufficiently reliable to distinguish necrosis or teratoma from viable tumors. Unresected teratoma or viable germ cell tumors are at least chemorefractory and if untreated will progress. According to EAU 2012 guidelines and recommendations RPLND in seminomas with residual mass is only indicated if a PET CT scan is positive. In nonseminomatous germ cell tumors retroperitoneal lymph node dissection is indicated for all residual radiographic lesions with negative tumor markers. Most common long term complication is loss of antegrade ejaculation, which can be prevented by a nerve-sparing or modified template resection.

Keywords: testicular germ cell tumors, chemotherapy, retroperitoneal lymph node dissection.