Accuracy of clinical staging in non-seminomatous testicular cancer--a single centre experience of retroperitoneal lymph node dissection.

The management of low stage non-seminomatous testicular cancer remains a controversial issue. Programs of surveillance or primary retroperitoneal lymph node dissection (RPLND) after orchiectomy show equally good survival rates. Current focus is therefore on reduction of toxicity or side effects of the treatment while maintaining maximal prognostic safety. The clinician's decision of therapy is based on clinical staging methods including computerized tomography, pulmonary x-rays and serum tumour marker levels. In this study, the accuracy of clinical staging was compared with histopathology in 64 patients with clinical stages (CS) I and IIa, operated upon with RPLND between 1980 and 1992. Lymph node metastases were histopathologically verified in 37% of CS I and in 47% of CS IIa tumours. Thus, the clinical staging was inaccurate in 37% in CS I and in 53% in CS IIa patients. No clear relationship was shown between the risk factors: vascular invasion and/or tumour marker levels and metastatic spread. The specificity of clinical staging in non seminomatous testicular cancer was low. RPLND, on the other hand, is a reliable method for assessment of metastatic spread and will minimise unnecessary use of chemotherapy. Modern techniques for lymphadenectomy have a very low rate of post-operative morbidity. Development of better non-invasive imaging techniques for detection of lymph node metastases is hoped for, in order to improve the information on tumour spread and make it possible to individualize therapy. Thus, unnecessary therapy and following side-effects can be avoided, improving the patient's quality of life during and after treatment.