Reduced retroperitoneal lymphadenectomy for clinical stage I non seminomatous germ cell testicular cancer

The best treatment of clinical stage I non-seminomatous germ cell testicular cancer (NSGCTC) is controversial. Lymphadenectomy allows an adequate retroperitoneal staging and cures up to 70% of patients in pathological stage II. The objective of this study is to analyse our experience in the treatment of this patients with radical orchiectomy and reduced retroperitoneal lymphadenectomy (RRL) as the initial treatment. Retrospective study of patients with clinical stage I NSGCTC submitted to radical orchiectomy and RRL at the Urology Service of the University of Chile Clinical Hospital, from January 1990 to December 2000. retroperitoneal staging with computed tomography (CT), normal tumor markers after orchiectomy and testicular and retroperitoneal biopsy informed at our hospital. The following metastatic risk factors in the testicular biopsy were checked: vascular invasion (venous and/or lymphatic), infiltration of tunica albuginea, rete testis, epididymis, and spermatic cord. 36 patients with 37 testicular tumors were analysed (1 bilateral case). Average age 28 years old. Twenty nine mixed tumors (78%); most frequent histology embryonal carcinoma (76%). Average surgery time 2 hr 7 min; average dissected lymph nodes 13. Introoperative complications: 2,8%; postoperative complications: a) early 5,6%; b) late: 5,6%. No mortality, no second surgeries nor blood transfusions. Four cases of positive RRL (11%). Only retroperitoneal relapses in 2 cases (8%), one out of the limits of dissection. Chemotherapy in 7 patients (19%) a total of 18 cycles. Four cases of contralateral tumor during follow-up (11%). Hundred percent survival at 76 months (16-160). We described sensibility, specificity, positive and negative predictive value of metastatic risk factors. Only epididymis infiltration was a significant predictor of metastasis (p=0,04). In our hands RRL is a safe surgery, with 5,6% mayor complications. The low false negative rate of CT in staging (11%) and the high number of retroperitoneal relapses (8%) in our study contrast with those of other publications. Limited by the size of our study group, the epididymis infiltration was the only statistically significant predictor of metastasis. Clinical stage I NSGCTC initially managed with RRL has a 100% survival.