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Current Urology Reports
Published in: Current Urology Reports 5/2013

01-10-2013 | Testis and Penile Cancer (M Manoharan and J Sheinfeld, Section Editors)

Critical Evaluation of Modified Templates and Current Trends in Retroperitoneal Lymph Node Dissection

Authors: Shane Pearce, Zoe Steinberg, Scott Eggener

Published in: Current Urology Reports | Issue 5/2013

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Abstract

Retroperitoneal lymph node dissection (RPLND) is a critical aspect of staging and treatment of nonseminomatous germ cell tumors (NSGCTs) of the testis. RPLND achieves cure in a majority of patients with low-volume metastatic disease and minimizes the need for chemotherapy. Initial surgical approaches to RPLND, involving wide limits to dissection, were associated with high rates of retrograde ejaculation and significant overall morbidity. Evolving modified RPLND templates helped reduce rates of retrograde ejaculation but may be associated with a 3 %–23 % risk of unresected metastasis. Modified templates have become a standard of care in primary RPLND with low-volume metastatic disease. Only highly select patients at specialized centers should undergo modified template RPLND in the postchemotherapy setting, because risks of unresected disease are higher than in the primary setting. Bilateral RPLND optimizes cancer control and can preserve antegrade ejaculation if nerve sparing is performed. We also briefly discuss minimally invasive approaches to RPLND.
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Metadata
Title
Critical Evaluation of Modified Templates and Current Trends in Retroperitoneal Lymph Node Dissection
Authors
Shane Pearce
Zoe Steinberg
Scott Eggener
Publication date
01-10-2013
Publisher
Springer US
Published in
Current Urology Reports / Issue 5/2013
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-013-0366-1

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