Retroperitoneal lymphadenectomy in staging and treatment. The development of nerve-sparing techniques.

Currently, where available and widely practiced, nerve-sparing RPLND offers the least toxic and safest alternative in management of clinical stage I nerve-sparing germ cell tumor. Twenty-six percent to 30% of such cases are found to be node positive and, if no adjuvant chemotherapy is elected, two thirds do not relapse; those who do are uniformly rescued by chemotherapy. The 70% who are node negative have no long-term toxicity and do better in quality of life studies than their surveillance counterparts. Also, risk-benefit and cost-benefit studies support the competitive position, of RPLND vis-à-vis the other options. Nonetheless, it is fair to say there are several options for management of clinical stage I nonseminomatous germ cell tumors that, when well applied, work well. Their choice depends on regional factors related to availability and experience.