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Primary Retroperitoneal Lymph Node Dissection for Stage II Seminoma: Is Surgery the New Path Forward?
Isamu Tachibana1, Andre Alabd1, Yan Tong2
1Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Summary
Primary retroperitoneal lymph node dissection (RPLND) is effective for clinical stage II seminoma, with a 2-year recurrence-free survival of 80.2%. Delayed disease presentation (>12 months) correlated with better surgical outcomes, suggesting surveillance may prevent overtreatment.
Area of Science:
- Urology
- Surgical Oncology
- Medical Oncology
Background:
- Clinical stage (CS) II seminoma is typically treated with chemotherapy or radiotherapy per National Comprehensive Cancer Network guidelines.
- Primary retroperitoneal lymph node dissection (RPLND) has emerged as a successful first-line therapy for retroperitoneal (RP)-only disease.
Purpose of the Study:
- To confirm the surgical efficacy of primary RPLND for CS IIA/IIB seminoma.
- To evaluate recurrence rates after primary RPLND and identify predictive clinical factors.
Main Methods:
- Retrospective review of 67 patients who underwent primary RPLND for RP-only seminoma between 2014 and 2021.
- Minimum 6-month follow-up for all patients; exclusion of patients receiving adjuvant chemotherapy from recurrence-free survival (RFS) analysis.
Main Results:
- The 2-year RFS for RPLND-only patients was 80.2%.
- Patients with delayed disease presentation (>12 months) had a superior 2-year RFS of 92.2%.
- Pathologic nodal stage and high-risk factors (tumor size >4 cm, rete testis invasion) did not significantly impact recurrence.
Conclusions:
- RPLND offers a surgical alternative to chemotherapy or radiotherapy for CS II seminoma, potentially avoiding treatment-related toxicity.
- Delayed presentation of CS II disease is associated with better surgical outcomes.
- Careful patient selection and surveillance may help avoid overtreatment in borderline cases; further research is needed.
