Role of Retroperitoneal Lymph Node Dissection in Management of Seminomatous Germ Cell Tumor: A Narrative Review

Testicular cancer (TC), the most common solid malignancy in young men, frequently presents as seminomatous germ cell tumor (SGCT), accounting for 60% of all testicular germ cell tumors (TGCT). Retroperitoneal lymph node dissection (RPLND) has emerged as an important option in the management of SGCT, in view of mounting evidence that chemotherapy and radiotherapy may lead to significant long-term complications, such as cardiovascular events, secondary malignancies, and infertility. This narrative review explores the current and evolving role of RPLND in SGCT management, emphasizing its potential to minimize treatment-associated morbidity. Recent advances in minimally invasive techniques, nerve-sparing approaches, and template dissections have reduced the morbidity historically associated with RPLND. This makes it a viable option for high-risk clinical stage I (CS1) SGCT, offering accurate pathological staging and reducing the need for overtreatment. In clinical stage II (CS2) SGCT, particularly non-bulky cases, RPLND is gaining acceptance as a primary treatment alternative to chemotherapy or radiotherapy, with encouraging outcomes and manageable long-term morbidity. RPLND also has a key role in managing post-chemotherapy residual masses, offering a curative approach when viable disease remains. Additionally, emerging biomarkers like miR371 show promise in refining patient selection for RPLND by improving identification of high-risk cases. While further studies are needed, RPLND represents a de-escalation strategy that can improve quality of life and long-term outcomes for patients with SGCT, especially those at early or intermediate stages of the disease.