Minimally invasive retroperitoneal lymph node dissection for stage IIA/B testicular seminomatous germ cell tumors

Background. According to primary orchiectomy data, up to 50–60 % of testicular germ tumors are seminomas. For stage IIA and IIB seminomas, radiotherapy (RT) and polychemotherapy (PCT) are generally accepted treatment standards with excellent 5-year survival up to 99 %. Despite high treatment efficacy, PCT and RT are accompanied by significant toxic effects which can severely decrease patients’ quality of life. Aim. To evaluate efficacy and safety of retroperitoneal lymph node dissection (RPLND) as a first stage of treatment after orchiectomy as an alternative to PCT and RT. Materials and methods. In total, 24 patients with stage IIA/B testicular seminomatous germ cell tumors without RT were selected. The patients were divided into groups: in the 1st group, robot-assisted RPLND without PCT after orchiectomy was performed (n = 14); in the 2nd group, PCT per the BEP scheme (bleomycin + etoposide + cisplatin) with subsequent laparoscopic RPLND after orchiectomy was performed (n = 10). In both groups, complications per the Clavien–Dindo classification, operative time, blood loss volume, hospital days, recurrence-free survival, presence of ejaculation after RPLND, histological conclusion, PCT toxicity were assessed. Results. Mean patient age was 38 years. Patient distribution per disease stage: 18 (75.0 %) patients with stage IIA, 6 (25.0 %) patients with stage IIB. There were no intraoperative vascular complications, no transition to laparotomy. Mean operative time was 267 ± 19.4 min. Mean blood loss volume was 174 ± 25 mL. Mean hospital days were 8 days. No significant postoperative complications (severity grade ≥IV per the Clavien–Dindo classification) were reported. In the late postoperative period, 2 patients required surgical treatment for lymphorrhea in the form of transcutaneous translumbar puncture with embolization of the lymph ducts under the control of flat detector computed tomography. Mean number of resected lymph nodes was 27.1. Viable tumor was verified in 2 (8.3 %) patients of the 1st group. Functional results: retrograde ejaculation in 11 (45.8 %) cases (in group 1: 3 (21.4), in group 2: 8 (80.0); p = 0.01). Recurrence-free survival in the 1st group (2-year observation) was 13.1 ± 1.9 (9.3–16.9) months, in the 2nd group (observation from 2013 to 2025), 57 ± 5.7 (11.0–116.8) months. None of the patients had signs of recurrence per clinical, instrumental or laboratory data. Conclusion. Prophylactic RPLND decreases the risk of recurrence and progression of germ line testicular tumors and allows to avoid risks of delayed toxicity associated with PCT and RT. In patients with stage IIA/B seminomas and low volume of residual retroperitoneal masses, RPLND provides good prognosis with minimal risks of treatment continuation in the future.