Modified retroperitoneal lymphadenectomy for testicular tumor: anatomical approach, operative technique and results.

Between January 1988 and June 1992, 56 patients underwent nerve-preserving retroperitoneal lymphadenectomy at the Department of Urology, University of Innsbruck. In 23 patients stage I, and in 33 patients stage II testicular tumors were found (staging according to the criteria recommended in Lugano 1979). Orchiectomy and subsequent lymphadenectomy within the boundaries described by Weissbach's group were performed for stage I tumors. In patients presenting with stage IIa or IIb tumors modified retroperitoneal lymphadenectomy within the boundaries suggested by Colleselli's group was performed. In stage IIc patients the residual tumor was resected after three cycles of polychemotherapy. If possible, nerve-sparing lymphadenectomy was performed. By adapting the operative technique to the respective tumor stage antegrade ejaculation could be preserved in 47 of these 56 patients. Semen analysis was carried out in 22 patients. The results in patients with stages I and IIa tumors were excellent, while in stages IIb and IIc patients' exocrine testicular function was considerably worse due to inductive polychemotherapy. None of the patients had a retroperitoneal recurrence. Of all 56 patients only one had a relapse in the lung (1.7%). The average follow-up period was 29 months.