According to the NCCN guidelines, stage II disease can be treated with a nerve-sparing RPLND or primary chemotherapy.
Figure 1 – Stage II disease
The guidelines also support surgery in early-stage disease due to high cure rates in the surgery alone that have been reported to be approximately 80%, with long-term toxicity being exceedingly low. Studies examining the role of surgery in stage Ia and IIb disease have shown very promising oncological outcomes (Table 1).
Table 1 – Oncological outcomes of RPLND:
Surgical complications of primary RPLND include short term issues such as scar formation, ileus at 3% and chylous ascites at 1%. The long-term issues include retrograde ejaculation in 1% of cases and small bowel obstruction in 1% of patients.
Dr. Cary continues to discuss why surgery has significant advantages when compared to chemotherapy or radiotherapy. Both chemotherapy and radiotherapy are associated with significant adverse effects later on in life as can be seen in figure 2.
Figure 2 – Survival and survivorship:
RPLND has evolved significantly during recent years, from a long and complicated procedure to become a short surgical procedure with a very low complication rate (Figure 3). Surgery alone results in cure in approximately 80% of cases with survival rates exceeding 96%. Long-term toxicity is minimal and surgical mortality is close to 0%.
Figure 3 - Historic and contemporary RPLND:
In summary, surgery for early-stage disease is curative in most patients when managed at high volume centers, and it also mitigates the risk of late toxicities.
Presented by: Clint Cary, MD, MPH, Indiana University School of Medicine, Indianapolis, Indiana
Written By: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA @GoldbergHanan at the 2020 Genitourinary Cancers Symposium, ASCO GU #GU20, February 13-15, 2020, San Francisco, California
Figure 3 - Historic and contemporary RPLND:
In summary, surgery for early-stage disease is curative in most patients when managed at high volume centers, and it also mitigates the risk of late toxicities.
Presented by: Clint Cary, MD, MPH, Indiana University School of Medicine, Indianapolis, Indiana
Written By: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA @GoldbergHanan at the 2020 Genitourinary Cancers Symposium, ASCO GU #GU20, February 13-15, 2020, San Francisco, California