The natural evolution of minimally invasive urologic oncology from laparoscopy to robotics laid the foundation for the first robotic-assisted laparoscopic RPLND
(R-RPLND) to be performed in 2006 by Davol et al.
The option of primary nerve-sparing RPLND
(followed by active surveillance for pN0, or by adjuvant chemotherapy for most pN+ cases) is available for highly selected cases, unable/not willing to undergo primary chemotherapy.
Abbreviations AFP -- [alpha]-fetoprotein HCG -- human chorionic gonadotropin LDH -- lactate dehydrogenaze MRI -- magnetic resonance imaging CT -- computed tomography MIBI -- methoxyisobutyl isonitrile FDG -- fluorodeoxyglucose PET-CT -- positron emission tomography--computed tomography PH -- pathohistology RPLND
-- retroperitoneal lymph node dissection DOI: 10.2298/MPNS1504109N
All the data was collected for initial presentation, risk factors, baseline stage, surgical procedures, histologic characteristics, first line chemotherapy regimens , number of cycles, second line chemotherapy regimen, postchemotherapy response evaluation on computed tomography (CT) imaging and tumor markers, retroperitoneal lymph node dissection (RPLND
), post-chemotherapy residuals histology, salvage therapy, disease free survival, pattern of relapse, over all survival and prognostic factors for treatment outcome.
Surgery, including a radical orchiectomy and RPLND
, is an important component for the treatment of testicular cancer.
All adjunctive treatment strategies beyond radical orchiectomy (chemotherapy, RPLND
, and radiation) are associated with potential fertility issues, either transient or permanent.
After multidisciplinary discussion of options, including chemotherapy and open/laparoscopic/robotic mass excision [+ or -] full bilateral RPLND
, the patient elected robotic mass excision.
Treatment options including RPLND
, chemotherapy, and active surveillance were discussed.
Treatment and Survival Rates of Men Diagnosed with Testicular Cancer 5 Year Survival Stage Histology Treatment Rate I Seminoma Orchiectomy, radiation therapy 97% I Nonseminoma Orchiectomy, RPLND
, surveillance 95% 1 year II Seminoma Nonbulky Tumor: Orchiectomy and 90% radiation therapy Bulky Tumor: Orchiectomy and 70% combination chemotherapy (cisplatin-based regimen) or by radiation therapy II Nonseminoma Orchiectomy and RPLND
, followed 95% by combination chemotherapy cisplatin, bleomycin, etoposide) III Seminoma Orchiectomy and multidrug 95% chemotherapy (cisplatin, bleomycin, etoposide) III Nonseminoma Orchiectomy and multidrug 70% chemotherapy (cisplatin, bleomycin etoposide Table 3.
On the surgical end of the spectrum, Daneshmand and colleagues provide the rationale and early experience with retroperitoneal lymph node dissection (RPLND
) for patients with small volume metastatic seminoma in an effort to avoid toxicities associated with either radiotherapy or chemotherapy, which are the treatment modalities typically used to manage these patients.
Of the 14 patients, 10 had post-chemotherapy retroperitoneal lymph node dissection (RPLND
), and corresponding testicular pathology was available in 8 of these cases.
However, evidence of surgery for metastatic disease affecting fertility issues was common knowledge prior to the 1990s, when a nerve-sparing technique and operative templates were devised for retroperitoneal lymph node dissection (RPLND
) (Kim et al., 2011).