Abstract
Postchemotherapy RPLND remains an integral part of management of testicular tumours. Nerve-sparing techniques can minimize the ejaculatory dysfunction due to the procedure. We report our functional and oncological outcomes for nerve-sparing RPLND in postchemotherapy settings. We analysed data from all patients undergoing nerve-sparing PC RPLND from January 1990 to December 2013 at our institute. Antegrade ejaculation and fertility issues were determined by patient history. Nerve sparing was achieved in 30% of patients undergoing PC RPLND. Of the 33 patients who underwent nerve-sparing PC RPLND, 19 (57.8%) had antegrade ejaculation. The mean time to antegrade ejaculation was 6.8 months. After a median follow-up of 75.61 months, 5-year disease-free survival was 98%. Nerve-sparing RPLND can improve functional outcomes without increasing recurrence rates in post chemotherapy setting.
Similar content being viewed by others
References
Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:359–386
Palumbo C, Mistretta FA, Mazzone E et al (2019) Contemporary incidence and mortality rates in patients with testicular germ cell tumors. Clin Genitourin Cancer 17:1026–1035
Gilligan T, Lin DW, Aggarwal R, Chism D, Cost N, Derweesh IH, Emamekhoo H, Feldman DR, Geynisman DM, Hancock SL, LaGrange C, Levine EG, Longo T, Lowrance W, McGregor B, Monk P, Picus J, Pierorazio P, Rais-Bahrami S, Saylor P, Sircar K, Smith DC, Tzou K, Vaena D, Vaughn D, Yamoah K, Yamzon J, Johnson-Chilla A, Keller J, Pluchino LA (2019) Testicular Cancer, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 17:1529–1554
Stevenson SM, Lowrance WT (2015) Epidemiology and diagnosis of testis cancer. Urol Clin N Am 42:269–275
Carver BS, Shayegan B, Eggener S, Stasi J, Motzer RJ, Bosl GJ, Sheinfeld J (2007) Incidence of metastatic non seminomatous germ cell tumor outside the boundaries of a modified postchemotherapy retroperitoneal lymph node dissection. J Clin Oncol 25:4365–4369
Donohue JP, Foster RS (1998) Retroperitoneal lymphadenectomy in staging and treatment: the development of nerve-sparing techniques. Urol Clin N Am 25:461–468
Gerdtsson A, Hakansson U, Tornblom M et al (2019) Surgical complications in postchemotherapy retroperitoneal lymph node dissection for nonseminoma germ cell tumor: a population based study from Swedish-Norwegian testicular cancer group. Eur Urol Oncol 8
Beck SDW, Bey AL, Bihrle R, Foster RS (2010) Ejaculatory status and fertility rates after primary retroperitoneal lymph node dissection. J Urol 184:2078–2080
Wahle GR, Foster RS, Bihrle R, Rowland RG, Bennett RM, Donohue JP (1994) Nerve sparing retroperitoneal lymphadenectomy after primary chemotherapy for metastatic testicular carcinoma. J Urol 152:428–430
Coogan CL, Hejase MJ, Wahle GR, Foster RS, Rowland RG, Bihrle R, Donohue JP (1996) Nerve sparing post chemotherapy retroperitoneal lymph node dissection for advanced testicular tumor. J Urol 156:1656–1658
Arai Y, Ishoitoya S, Okubo K et al (1997) Nerve sparing retroperitoneal lymph node dissection for metastatic testicular cancer. Int J Urol 4:487–492
Nonomura N, Nishimura K, Takaha N et al (2002) Nerve sparing retrtoperitoneal lymph node dissection for advanced testicular cancer after chemotherapy. Int J Urol 9:539–544
Pettus JA, Carver BS, Masterson T, Stasi J, Sheinfeld J (2009) Preservation of ejaculation in patients undergoing nerve sparing postchemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer. J Urol 73:328–331
Miki T, Mizutani Y, Nakamura T, Kawauchi A, Nagahara A, Nonomura N, Okuyama A (2009) Post chemotherapy nerve sparing retroperitoneal lymph node dissection for advanced germ cell tumor. Int J Urol 16:379–382
Luz MA, Kotb FA, Aldousari S et al (2010) Retroperitoneal lymph node dissection for residual masses after chemotherapy in nonseminomatous germ cell testicular tumor. World J Surg Oncol 8:97
Steiner H, Zangerl F, Stohr B et al (2008) Results of bilateral nerve sparing laparoscopic retroperitoneal lymph node dissection for testicular cancer. J Urol 180:1348–1353
Beck SDW, Foster RS, Bihrle R, Donohue JP, Einhorn LH (2007) Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor? Cancer. 110:1235–1240
Heidenreich A, Pfister D, Witthuhn R, Thuer D, Albers P (2009) Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol 55:217–226
Matos E, Skrbinc B, Zakotnik B (2010) Fertility in patients treated for testicular cancer. J Cancer Surviv 4:274–278
Woldu SL, Moore JA, Ci B, Freifeld Y, Clinton TN, Aydin AM, Singla N, Krabbe LM, Hutchinson RC, Amatruda JF, Sagalowsky A, Lotan Y, Arriaga Y, Margulis V, Xie Y, Bagrodia A (2018) Practice patterns and impact of postchemotherapy retroperitoneal lymph node dissection on testicular cancer outcomes. Eur Urol Oncol 1:242–251
Singh P, Yadav S, Mahapatra S, Seth A (2016) Outcomes following retroperitoneal lymph node dissection in postchemotherapy residual masses in advanced testicular germ cell tumors. Indian J Urol 32:40–44
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Raja, A., Malik, K., Kathiresan, N. et al. Nerve-Sparing Postchemotherapy Retroperitoneal Lymph Node Dissection (PC RPLND) for Nonseminomatous Germ Cell Tumour: Experience from a Tertiary Cancer Centre. Indian J Surg Oncol 12, 374–377 (2021). https://doi.org/10.1007/s13193-021-01313-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-021-01313-9