Unilateral Lymphadenectomy in Intraoperative Stage I Nonseminomatous Germinal Testis Cancer

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Abstract
Bilateral retroperitoneal lymphadenectomy is mainly a staging procedure in patients with stage I nonseminomatous testis cancer, and it causes permanent loss of antegrade ejaculation in .apprx. 2/3 of the cases. Consecutive patients (61) with no intraoperative evidence of lymph node involvement underwent unilateral retroperitoneal lymphadenectomy for nonseminomatous germinal testis tumors. Microscopic metastases were found in 1 to 4 retroperitoneal nodes in 6 cases (9.8%). Antegrade ejaculation was absent postoperatively in 11 patients (18%), with no significant difference between patients who underwent lymph node dissection on the left or right side. Ejaculation returned spontaneously in 3 patients, 1 of whom fathered a child. The disease recurred in 10 patients 3-35 mo. after lymphadenectomy (median 6 mo.). Disease recurred in 8 of 55 patients (14.5%) with negative nodes and 2 of 6 (33.3%) with positive histological findings. No patient suffered retroperitoneal recurrence. The more than 3-yr survival rates free of disease were 96.4 and 83.3% in patients with pathological stages I and II disease, respectively. Unilateral retroperitoneal lymphadenectomy in patients with intraoperative stage I nonseminomatous germinal testis cancer preserves antegrade ejaculation in more than 80% of the cases without apparently compromising the long-term survival.