Evolving concepts in surgical management of testis cancer

Abstract

Nonseminomatous germ cell tumor is an extraordinary tumor in terms of demonstrating the impact of regional lymphadenectomy on survival. Over the years many series have shown that node-positive (pathologic stage II) patients can still be cured with local measures in excess of 50% of the lymphatic drainage predictable. These relate to features of anatomic descent of the gonad and its associated lymphatics. A number of topographic studies have supported the regional deposition of metastatic disease, and we have a good understanding of this. More importantly, there are biologic considerations that probably lend to the opportunity for cure with testis cancer patients with surgery alone. Many patients will have teratomatous elements that have somewhat lower metastatic potential. What is fascinating, however, is that even undifferentiated germ cell tumors, such as embryonal cancer, still are often cured with lymphadenectomy alone. Data recently presented in the New England Journal of Medicine in the cooperative multi-institutional study show that a control group treated with node dissection alone had more than half of the patients as long-term survivors without relapse [1].