Why retroperitoneal lymphadenectomy for testicular tumors?

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 much more controversy regarding the management of patients with non-seminomatous tumors. Because lymphangiography has an accuracy of about 90 per cent the justification of a retroperitoneal lymphadenectomy for staging purposes is no longer valid. Irradiation of the retroperitoneal and pelvic lymph nodes in a good survival rate for patients with clinical stages I and II diseases. It is anticipated that with limited resection in selected stage IIB patients and with 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 rate are available.