Thoracoabdominal retroperitoneal lymphadenectomy for nonseminomatous testicular cancer

Retroperitoneal lymphadenectomy remains a mainstay of the management of patients with nonseminomatous testicular cancer. The operation provides accurate information regarding stage and prognosis, which current preoperative staging studies cannot duplicate. The therapeutic value of lymphadenectomy has been demonstrated more clearly for testicular tumors than for any other cancer. Properly performed, the operation results in complete removal of all node-bearing tissue at significant risk of harboring metastases. Yet the morbidity and mortality are low in these young, generally vigorous patients. The only long-term sequela is loss of ejaculation. Efforts are currently underway to determine limits to the operation that will preserve ejaculation while maintaining the efficacy of the procedure.