Current Status of Retroperitoneal Lymph Node Dissection and Testicular Cancer: When to Operate

BACKGROUND: Historically, retroperitoneal lymph node dissection (RPLND) has been used in the therapy of both low-stage and high-stage testicular cancer after chemotherapy. As other therapies have developed, the role of RPLND has also evolved. METHODS: The authors review the current indications for RPLND in the therapy of testicular cancer. RESULTS: Metastatic testicular cancer can be cured in 50% to 75% of cases by surgical removal using RPLND, depending on the volume of metastasis. In postchemotherapy disease, the surgical removal of teratoma or carcinoma also confers a therapeutic benefit to the patient. CONCLUSIONS: The therapeutic capability of RPLND in low-stage testicular cancer is underappreciated. In postchemotherapy disease, this therapeutic capability is retained if the patient has carcinoma or teratoma in the metastatic tumor. In postchemotherapy disease, efforts continue to appropriately select patients preoperatively who have only fibrosis and necrosis in the specimen and therefore do not derive therapeutic benefit from RPLND.