The question of retroperitoneal lymph node dissection for clinical stage I non-seminomatous testis tumors

Fifty retroperitoneal lymph node dissection (RPLND) performed by the same surgeon on 45 clinical stage I and in 5 clinical stage II cases of non seminomatous testis tumors were reviewed. Of the 45 clinical stage I patients, 12 revealed retroperitoneal lymph node involvement. Of the 17 stage II cases, one survived for more than 4 years and 3 for more than 6 years with no other treatment. There was no evidence of recurrence. Eight patients with no other treatment died within one year and a half of RPLND. Five patients, some with gross nodal disease are alive with no evidence of recurrence after RPLND and chemotherapy (PVB) (Einhorn, Donohue 1977). Of the 50 patients, only two preserved ejaculation. The author questions the systematic use of RPLND in clinical stage I testis tumors. In view of the improvement of chemotherapy agents, he favors the option of careful surveillance of these patients, who should benefit from chemotherapy and eventually surgical resection according to the progress of the disease.