Efficacy of modified retroperitoneal lymph node dissection for testicular nonseminomatous germ cell tumors

BACKGROUND OBJECTIVE: Retroperitoneal lymph node dissection(RPLND) is one of the main modalities for nonseminomatous germ cell tumors (NSGCTs). RPLND has achieved relatively high efficacy for stage I / II NSGCTs. Currently, the postoperative complication rate of conventional RPLND is relatively high. This study was to summarize therapeutic efficacy of modified RPLND for stageⅠ / Ⅱ NSGCTs, thus to explore the reasonable therapy strategy for those diseases. METHODS: Clinical data of 31 patients with stage I / II NSGCTs underwent RPLND from Aug.2003 to Aug.2007 in Sun Yat-sen University Cancer Center, were retrospectively analyzed. All cases received modified RPLND after radical orchidectomy. Four cases received two to three cycles of BEP (bleomycin,etoposide and cisplatin) chemotherapy prior to RPLND. Thirteen cases received one to five cycles of adjuvant cisplatin-based chemotherapy after primary RPLND. RESULTS: The mean operating time was 147 min (rang 120-200 min) and the mean blood loss was 116 ml (rang 50-300 mL) of modified RPLND. The mean number of dissected lymph nodes sent for pathological examination was 15 (rang 3- 40). Retroperitoneal lymph node metastases were confirmed in 15 cases, two of which were fibrosis. According to the pathologic classification after operation, there were 16 cases at stage I, six cases at stage IIA, six cases at stage IIB, and three cases at stage IIC. There was no occurrence of perioperational and postoperational complications. The mean follow-up time was 33 months, ranged eight to 58 months. Twenty-nine patients achieved tumor-free survival, without elevation of blood alpha-fetal protein (AFP) or human chorionic gonadotropin (HCG). One patient developed postoperative recurrence in the retroperitoneum 17 months after operation. After receiving two cycles of salvage therapy, his serum AFP and beta-HCG returned to normal ranges. Another patient had metastasis in the liver and lung six months after operation, but achieved complete response after six cycles of adjuvant cisplatin-based chemotherapy. Antegrade ejaculation was preserved in 96.8% of patients. The mean operative time was 175 vs. 143 min(P=0.002), and the blood loss was 200 vs.104 mL in the group with and without preoperative chemotherapy, respectively(P0.001). CONCLUSIONS: Modified RPLND achieves satisfactory results for stageⅠ / Ⅱ NSGCTs patients. It decreases damages to normal organs as well as causes less perioperative and postoperative complications compared to conventional PRLND.