Retroperitoneal Lymph Node Dissection for Early Metastatic Testicular Seminoma

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In a phase II trial reported in the Journal of Clinical Oncology, Daneshmand et al found that first-line retroperitoneal lymph node dissection (RPLND) was associated with good outcomes in patients with testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy.

As stated by the investigators, “The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. RPLND is an established treatment for testicular germ cell tumors with minimal late morbidity, although little data exist on its efficacy in early metastatic seminoma.”

Study Details

In the study, 55 patients with isolated retroperitoneal lymphadenopathy (1 to 3 cm) were enrolled at sites in the United States and Canada. Patients underwent open RPLND performed by certified surgeons. The primary outcome measure was 2-year recurrence-free survival.

Among all patients, median largest clinical lymph node size was 1.6 cm (interquartile range [IQR] = 1.3–1.9 cm) and median largest lymph node size on RPLND pathology was 2.3 cm (IQR = 0.9–3.5 cm). Overall, 9 patients (16%) were pN0, 12 (22%) were pN1, 31 (56%) were pN2, and 3 (5%) were pN3. One patient received adjuvant chemotherapy.

During a median follow-up of 33 months (IQR = 12.0–61.6 months), 12 patients (22%) experienced recurrence. Median time to recurrence was 10.2 months (range = 7.3–31.6 months). Recurrence-free survival at 2 years was 81%. By pathologic stage, 2-year rates were 100% for pN0, 92% for pN1, 74% for pN2, and 67% for pN3. Treatment-free survival at 2 years was 83%. Overall survival at 2 years was 100%.

Among the 12 patients with recurrence, 10 received chemotherapy and 2 underwent additional surgery. At last follow-up, all of these 12 patients were disease-free.

A total of four patients (7%) had short-term complications, consisting of ileus and pulmonary embolism in one patient and incision ulceration, ileus, and chylous ascites in one each. Long-term complications (> 30 days) occurred in four patients (7%), consisting of incision hernia and three cases of anejaculation.  

The investigators concluded, “RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.”

Siamak Daneshmand, MD, of the USC Catherine and Joseph Aresty Department of Urology, USC Norris Comprehensive Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Think Different Foundation. For full disclosures of the study authors, visit

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