Open retroperitoneal lymph node dissection.

Testicular cancer has become one of the most curable solid malignancies. Although chemotherapy can rescue patients with advanced disease, accurate staging of the retroperitoneum has been a mainstay of effectiveness of treatment. Retroperitoneal lymph node dissection via open technique has been and remains the gold standard for pathologic staging of the retroperitoneum as well as effective therapy for patients with minimal nodal involvement. Retroperitoneal lymphadenectomy has resulted in a 99.5% tumor survival for patients with clinical stage I or early stage II disease. Alternatives to open retroperitoneal lymph node dissection include laparoscopic retroperitoneal lymph node dissection, active surveillance, or primary chemotherapy. Each of these modalities has a potential role in selected patients. For the majority of patients, however, a meticulous retroperitoneal lymph node dissection gives patients the highest likelihood of survival with relatively low morbidity.