Why Retroperitoneal Lymphadenectomy for Testicular Tumors?

Abstract

Most patients with seminoma can be managed successfully with irradiation after a high inguinal orchiectomy. Since anaplastic seminoma has a high predilection for dissemination adjuvant chemotherapy with an alkylating agent, such as L-phenylalanine mustard, is advised. There is more controversy regarding the management of patients with nonseminomatous tumors. Because lymphangiography has an accuracy of about 90% the justification of a retroperitoneal lymphadenectomy for staging purposes is no longer valid. Irradiation of the retroperitoneal and pelvic lymph nodes resulted in a good survival rate for patients with clinical stage I and II disease. With limited resection in selected stage IIB patients and the judicious use of elective or adjuvant chemotherapy the results in these patients may be improved further. The morbidity associated with retroperitoneal lymphadenectomy is no longer justified since equally effective alternative approaches with lower morbidity rates are available.