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Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II Seminoma: A Systematic Review and Meta-Analysis of Safety and Oncological Effectiveness - Beyond the Abstract

Testicular germ cell tumor (TGCT), the most common malignancy in young men, is highly curable, even in advanced stages. Radiotherapy or chemotherapy is the standard treatment for clinical stage (CS) II seminomatous TGCT, with cancer-specific survival greater than 90%

However, these strategies are hindered by significant short- and long-term morbidity, making the choice of therapeutic modality challenging and consequences definitive. Our recent systematic review and meta-analysis provided cumulative summarized evidence on the rising role of primary RPLND in patients with CS II seminomatous TGCT. Primary RPLND promises to provide better treatment-related morbidity while offering comparable oncological outcomes to the current standard of care. We demonstrated that the overall and infield recurrence rates were 0.14 (95% CI: 0.08-0.22) and 0.04 (95% CI: 0.00-0.11), respectively, with an overall median follow-up of 38 months. The overall pooled rate of ≥ Clavien Dindo grade III complications was 0.04 (95% CI: 0.01-0.10). Moreover, antegrade ejaculation was preserved with an overall pooled rate of 0.98 (95% CI: 0.95-1.00). Current data from phase II trials and retrospective cohorts show evidence of favorable oncologic outcomes with primary RPLND in patients with CS II seminoma. Other suggested benefits of primary RPLND include accurate pathological lymph node staging and a reduction in late side effects compared with chemotherapy and radiotherapy. However, long-term results of randomized phase III trials in high-volume centers are needed to ensure optimal survival benefit and aid therapeutic decision-making and patient counseling.

Written by: Mehdi Kardoust Parizi,1,2 Vitaly Margulis,3 Aditya Bagrodia,4 Kensuke Bekku,1,5 Jakob Klemm,1,6 Akihiro Matsukawa,1,7 Arman Alimohammadi,1 Reza Sari Motlagh,1 Hadi Mostafaei,1 Ekaterina Laukhtina,1,8  Shahrokh F. Shariat1,3,8,9,10,11

  1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
  2. Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  3. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  4. Department of Urology, University of California San Diego, San Diego, CA USA.
  5. Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  6. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  7. Department of Urology, Jikei University School of Medicine, Tokyo, Japan
  8. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
  9. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.
  10. Departments of Urology, Weill Cornell Medical College, New York, New York, USA.
  11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
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