Retroperitoneal Lymph Node Dissection In Patients With High Risk Testicular Cancer – We performed a retrospective review of retroperitoneal lymph node dissection (RPLND) patients with high risk features (>30% embryonal carcinoma, with or without lymphovascular invasion) and compared primary (P-RPLND) versus post-chemotherapy (PC-RPLND) patients. The average percent embryonal carcinoma between P-RPLND vs. PC-RPLND was 75.3 vs. 71.2%, respectively. The average LVI between P-RPLND vs. PC-RPLND was 53.4 vs. 61.4%, respectively.

Regarding pathologic stage II (PS II) disease, there were 37 (49%) and 35 (61%) cases, respectively. Only 2 (3%) of patients who underwent P-RPLND were noted to have systemic disease outside the retroperitoneum (metastasis to the lung and mesentery each). Overall, there were 6 (8%) and 5 (9%) recurrences between the P-RPLND and PC-RPLND groups all within 2 years of surgery.

P-RPLND offered less blood loss, shorter operative time and fewer complications than PC-RPLND. Our findings highlight that P-RPLND can spare a majority of these high risk patients the potential long-term toxicity of chemotherapy compounded by radiation exposure from surveillance imaging.