Difficulties in laparoscopic retroperitoneal lymph node dissection

Abstract

Malignant testicular cancers, both seminomas and nonseminomatous germ cell tumors (NSGCT), can be cured with a very high success rate when correctly managed. For seminomas, retroperitoneal lymph node dissection (RPLND) is rarely indicated. For NSGCTs, which differ substantially from seminomas, the mainstays of successful management are RPLND and chemotherapy, used either alone or in combination. However, RPLND and chemotherapy are both associated with specific morbidities, which increase significantly if the two therapies are combined. Because the therapeutic efficacy of RPLND cannot be further improved significantly, the goal in management of low-stage NSGCT and especially of clinical stage I NSGCT is reduction in morbidity without compromising the cure rate.