Retroperitoneal lymph node dissection for testicular cancer

Abstract

  Testicular cancer is the most common solid tumor in adolescent and young adult men. Most patients with metastases from testicular cancer have enlarged retroperitoneal lymph nodes. The treatment for testicular cancer has improved, and even patients with metastases are expected to achieve long-term survival by appropriate treatment with chemotherapy and/or post-chemotherapy residual tumor resection, including retroperitoneal lymph node dissection (RPLND). Consequently, RPLND plays an important role in the treatment of testicular cancer.

  The aim of post-chemotherapy residual tumor resection is to determine if any cancer cells remain and to remove teratomas. Post-chemotherapy RPLND is generally performed by template when testicular tumor markers are normalized and retroperitoneal lymph node metastases remain. The right-sided template includes para-caval and inter-aortocaval lymph nodes, and the left-sided template includes para-aortic lymph nodes between the renal and iliac arteries. The postganglionic sympathetic fibers from the lumbar splanchnic nerves run in that area, and resection of these fibers by bilateral RPLND results in ejaculatory dysfunction. To reduce postoperative ejaculatory dysfunction, it is important to preserve the nerves as much as possible during bilateral RPLND.

  In Japan, laparoscopic RPLND (L-RPLND) became covered under the national health insurance system in 2020. L-RPLND is performed with a template including post-chemotherapy residual tumor when retroperitoneal lymph node metastases before chemotherapy are limited. In this chapter, RPLND for testicular cancer is summarized based on our experience in our department.