Postchemotherapy retroperitoneal lymph node dissection continues to play a pivot role in the treatment of testicular cancer. The choice of chemotherapy regimen on the results of final pathology have been examined. There may be a higher rate of active tumor in patients receiving 4 cycles of EP than 3 cycles of BEP. However a separate study showed a higher rate of teratoma for 3 cycles of BEP than for 4 cycles of EP. Further studies are needed to clarify these results.
For patients with pure seminoma, a PET scan should be performed for residual masses greater than 3cm, with resultant surgery for PET avid masses. In contrast, the removal of all residual masses greater than 1cm for patients with non-seminomatous germ cell tumors is the standard of care, and there is no role for a PET scan.
The use of templates to limit the morbidity of the procedure have been examined in single institution studies with varying entry criteria. When feasible, and when oncologic outcomes are not compromised, a modified template or nerve sparing technique may be utilized. Additionally, minimally invasive surgery has evolved and can be utilized in centers with extensive laparoscopic or robotic experience
Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.