Retroperitoneal lymph node dissection in testis cancer (CME)
RPLND alone provides up to 90% cure in patients with low-volume, low-risk testis cancer and eliminates the risk of teratoma and viable tumor in the retroperitoneum in those with high-risk disease.
Key Points
RPLND has undergone numerous modifications since its inception in the early 1900s. The original procedure was performed as a bilateral template, which included the renal suprahilar lymph nodes. The suprahilar dissection was eventually excluded in the bilateral-template RPLND due to low risk of potential seeding and limited compromise to patient outcome with fewer related complications.4
The next modification of the traditional RPLND was development of left- and right-side templates to limit the antegrade ejaculatory dysfunction often associated with bilateral-template RPLND. Template development was aided by studying the sympathetic paravertebral ganglionic chains and the anatomy of the post-ganglionic sympathetic fibers.6 These fibers originate from T12-L3 and are responsible for antegrade ejaculation.
