Primary retroperitoneal lymph node dissection in clinical stage A non-seminomatous germ cell testis cancer. Review of the Indiana University experience 1965-1989.

The results of primary retroperitoneal lymph node dissection (RPLND) in 464 patients with clinical stage A non-seminomatous germ cell (NSGC) testis cancer treated over 25 years (1965-1989) were reviewed. The results were analysed in clinical terms and subdivided into early (1965-1978) and contemporary (1979-1989) groups in order to be comparable with series using radiotherapy or surveillance. Between 1965 and 1978 (86 clinical stage A patients) the overall relapse rate of 15% (n = 13) was similar to that of radiotherapy series but survival (97.7% after RPLND) was superior to that achieved with irradiation (87%). From 1979 to 1989, 378 clinical stage A patients had primary RPLND and 30% of them (n = 112) had cancerous nodes. The relapse rate for pathological stage A (n = 266) was 12% and 2 patients died. The relapse rate in pathological stage B patients without adjuvant chemotherapy was 34%. No relapse was seen among 48 pathological stage B patients who received post-operative adjuvant chemotherapy. The death rate was 0.8% among 378 clinical stage A RPLND patients. While not statistically significantly different from death rates reported in current surveillance series, these consistent results spanning 2 eras (before and after cisplatin) over 25 years suggest a sound basis for the surgical approach. The anatomical and medical principles in oncology, which have supported this approach, still remain cogent today. Now that nerve-sparing techniques have been developed, the only long-term morbidity of RPLND (anejaculation) has been avoided. It would seem appropriate to include nerve-sparing RPLND techniques in the management of clinical stage A disease.