Surveillance versus nerve-sparing retroperitoneal lymphadenectomy in stage I nonseminomatous germ-cell tumors

As in any health care situation, treatment for stage I nonseminomatous germ-cell tumor of the testis must be adapted to the needs of the individual patient, and a surveillance protocol may not always provide optimal care. Of concern is the relative paucity of information about relapse rates beyond 4 years, the long-term effects of salvage chemotherapy, and the potential of subclinical disease to become manifest many years after diagnosis. However, for the reliable patient with a stage I tumor demonstrating no histopathologic features indicative of a high risk of relapse, close surveillance may offer the advantages of a high likelihood of survival with less intervention and lower morbidity.