Balakrishnan Gurushankari, Ramamurthy Jaganmurugan, Krishnamurthy Shalini Shree, Malik Kanuj, Menon Arun Ramdas, Radhakrishnan Venkataraman, Suresh Krishna, Raja Anand
Department of Surgical Oncology, Cancer Institute- Women India Association (WIA), Chennai, India.
Department of Surgical Oncology, M.D. Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2025 Jul 16. doi: 10.1245/s10434-025-17802-y.
Bilateral retroperitoneal lymph node dissection (RPLND) has been the standard of care in non-seminomatous germ cell tumor (NSGCT) with residual nodes following chemotherapy. Extensive dissection leads to increased morbidity, especially sexual dysfunction. Hence, avoiding contralateral RPLND in select patients can reduce morbidity without affecting oncological outcomes. This article explores the feasibility of one such option.
Patients diagnosed with testicular NSGCT with metastasis to the ipsilateral retroperitoneal (RP) lymph node template measuring ≤ 5 cm, and no involvement of the contralateral RP template (defined as low volume metastasis), who received chemotherapy and underwent bilateral RPLND, were included in the study. Clinicopathological data, perioperative complications, and oncological outcomes were collected retrospectively and analyzed.
A total of 33 patients were analyzed who had undergone open bilateral RPLND with contralateral nerve-sparing template for NSGCT following chemotherapy. The median age of patients was 25.8 years, with a median follow-up of 75.6 months. A total of 14 patients reported absent ejaculation, 19 reported normal ejaculation, and 7 had decreased volume. Histology of contralateral RPLN was normal in all patients. The 5-year disease-free survival was 98%, and 5-year overall survival was 100%.
Our data on bilateral RPLND for patients with NSGCT (meeting criteria for low-volume disease) following chemotherapy shows the absence of metastasis to the contralateral RPLN with good disease-free survival and overall survival. Hence, a future option of avoiding contralateral RPLND can be offered in select patients to reduce morbidity without compromising oncological outcomes.
双侧腹膜后淋巴结清扫术（RPLND）一直是化疗后残留淋巴结的非精原细胞性生殖细胞肿瘤（NSGCT）的标准治疗方法。广泛清扫会导致发病率增加，尤其是性功能障碍。因此，在特定患者中避免对侧RPLND可降低发病率，且不影响肿瘤学结局。本文探讨了其中一种选择的可行性。
纳入诊断为睾丸NSGCT且同侧腹膜后（RP）淋巴结转移灶直径≤5 cm、对侧RP模板未受累（定义为低体积转移）、接受化疗并接受双侧RPLND的患者。回顾性收集并分析临床病理数据、围手术期并发症和肿瘤学结局。
共分析了33例化疗后因NSGCT接受开放性双侧RPLND并采用对侧保留神经模板的患者。患者的中位年龄为25.8岁，中位随访时间为75.6个月。共有14例患者报告无射精，19例报告射精正常，7例射精量减少。所有患者对侧RPLN的组织学均正常。5年无病生存率为98%，5年总生存率为100%。
我们关于化疗后NSGCT患者（符合低体积疾病标准）双侧RPLND的数据显示，对侧RPLN无转移，无病生存率和总生存率良好。因此，未来可在特定患者中提供避免对侧RPLND的选择，以降低发病率，同时不影响肿瘤学结局。
