Can Contralateral Template Dissection be Avoided in Post-chemotherapy Retroperitoneal Lymph Node Dissection for Non-seminomatous Germ Cell Tumors?

BACKGROUND

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 AND METHODS

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.

RESULTS

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%.

CONCLUSIONS

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.