Ondřej Havránek1, Jan Krhut1, Jaroslav Hájek2, Jozef Kopecký1, David Feltl2
Objective: To evaluate oncological results and functional results of modified retroperitoneal lymhadenectomy with resection limited to enlarged residual lymph nodes in patients after chemotherapy for metastatic nonseminomatous germinal cell testicular cancer. Material and methods: We made a retrospective study in 14 patients undergoing retroperitoneal lymphadenectomy for residual tumour in the retroperitoneum after chemotherapy for nonseminomatous testicular cancer between 2000-2006. Average age was 33.4 years, average follow up after surgery 56 months. Eight patients (57.1 %) were treated by 3-4 cycles of the first line chemotherapy (CHT) and 6 patients underwent surgery after next 2-5 cycles of the second line CHT. The extend of surgery was limited to macroscopically enlarged lipolymphatic tissue. Results: Histology showed necrosis in 11 cases (78.6 %) and viable carcinoma in 3 cases (21.4 %). Ten patients with negative histology were observed. One patient with positive histology was treated by radiotherapy and 2 patients with positive histology received adjuvant CHT. All patients have preserved ejaculation after surgery. All of the patients are surviving without progression of the disease. Conclusion: Both classical bilateral and modified retroperitoneal lymphadenectomy in patients after CHT for nonseminomatous testicular cancer is a procedure with high risk of peri- and postoperative morbidity. Modified procedure with resection of enlarged residual lymph node only may reduce the risk of postoperative morbidity. Especially it can preserve the physiological ejaculation. The oncological outcomes were similar with procedures with standard extend of lymphadenectomy.