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JU INSIGHT Primary Retroperitoneal Lymph Node Dissection for Seminoma Metastatic to the Retroperitoneum
By: Richard S. Matulewicz, MD, MSCI, MS, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medical College, New York, New York; Nicole Benfante, BS, Memorial Sloan Kettering Cancer Center, New York, New York; Samuel A. Funt, MD, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medical College, New York, New York; Darren R. Feldman, MD, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medical College, New York, New York; Brett Carver, MD, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medical College, New York, New York; Alexander Doudt, DO, Memorial Sloan Kettering Cancer Center, New York, New York; Andrea Knezevic, MS, Memorial Sloan Kettering Cancer Center, New York, New York; Joel Sheinfeld, MD, Memorial Sloan Kettering Cancer Center, New York, New York, Weill Cornell Medical College, New York, New York | Posted on: 19 Jan 2024
Matulewicz RS, Benfante N, Funt SA, et al. Primary retroperitoneal lymph node dissection for seminoma metastatic to the retroperitoneum. J Urol. 2024;211(1):80-89.
Study Need and Importance
Primary surgical treatment with retroperitoneal lymph node dissection (RPLND) aims to accurately stage and treat patients with node-positive pure seminoma while avoiding long-term risks of chemotherapy or radiation.
What We Found
We report the outcomes of 45 patients treated with primary RPLND over a 10-year period for clinical stage II or relapsed clinical stage I pure seminoma. Among patients (n = 29) managed with post-RPLND surveillance, the 2-year recurrence-free survival was 81% (95% CI 57-93; Figure). These outcomes corroborate recently reported phase II studies and support primary RPLND as a safe, highly effective treatment that may obviate the need for chemotherapy for most patients. In our series, all patients received an open bilateral template operation. There were no retroperitoneal recurrences, suggesting a potential benefit to this approach over modified template operations. We also provide the first report of outcomes among select patients receiving adjuvant chemotherapy (2 cycles of etoposide and cisplatin) following primary RPLND. In these patients, 2-year recurrence-free survival was 92% (95% CI 54-99). All patients are alive and free of disease following treatment regardless of adjuvant management strategy.
Limitations
Adjuvant management following RPLND was not standardized, and roughly one-third of the cohort elected for adjuvant 2 cycles of etoposide and cisplatin. Therefore, selection bias may have influenced our outcomes, as patients at higher risk for relapse may have been selected or self-selected for adjuvant chemotherapy. Additionally, the median follow-up for nonrelapsing patients managed with surveillance was 18.5 months, which is slightly shorter than the completed phase II studies.
Interpretation for Patient Care
Primary surgery is safe and effective for patients with testicular pure seminoma with low-volume metastases in the retroperitoneal lymph nodes. Most men treated with surgery in this series did not experience recurrence and were able to avoid chemotherapy or radiation treatment.
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