Postchemotherapy Retroperitoneal Lymph Node Dissection

Abstract

Surgical resection of postchemotherapeutic residual masses represents an integral part oft he multimodality treatment in patients with advanced testis cancer. The reationale to resect residual masses is due to the fact that about 30–40 % and 10 % of patients harbour teratoma and vital cancer, respectively, in the residual masses. Resection of these masses is done with a curative intent so that it is mandatory to resect all masses independent on their location and size. Small residual masses < 1cm can be followed if the patient initially was staged with good or intermediate prognosis. In the remainder a modified template resection can be done if the masses are located in the primary landing zone oft he tumour bearing testicle and < 5cm in size. In all other cases, a full bilateral template has to be resected. Approximately, 10 % oft he patients need to undergo resection of adjacent structures such as the kidney, the aorta, inferior vena cava or vertebral bodies. The surgeon has to identify these lesions preoperatively and it mandatory to develop an interdisciplinary approach. Postchemotherapy surgeries should be done in tertiary referral centres only.