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Review
. 2024 Apr;26(4):318-335.
doi: 10.1007/s11912-024-01511-y. Epub 2024 Mar 2.

Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives

Bartosz Małkiewicz  1 , Gabriela Świrkosz  2 , Wojciech Lewandowski  2 , Katarzyna Demska  2 , Zuzanna Szczepaniak  3 , Jakub Karwacki  2 , Wojciech Krajewski  2 , Tomasz Szydełko  4
Affiliations
Review

Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives

Bartosz Małkiewicz et al. Curr Oncol Rep. 2024 Apr.

Abstract

Purpose of review: This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions.

Recent findings: RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.

Keywords: Lymph node metastasis; Lymphadenectomy; Retroperitoneal lymph node dissection; Retroperitoneal lymph nodes; Testicular cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Anatomical extent of lymphadenectomy in testicular cancer. A Bilateral template. B Right unilateral template. C Left unilateral template
Fig. 2
Fig. 2
An overview of intra- and postoperative complications of lymphadenectomy in testicular cancer management. ARDS, acute respiratory distress syndrome; UTI, urinary tract infection; C. difficile, Clostridium difficile
Fig. 3
Fig. 3
Modern risk factors for metastasis in lymph nodes in testicular cancer. AGR, albumin-globulin ratio; DRR, de Ritis ratio; NLR, neutrophil-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio
Fig. 4
Fig. 4
The guidelines provided by the European Association of Urology on the treatment decision-making process after lymphadenectomy in testicular cancer. RPLND, retroperitoneal lymph node dissection; PS, pathologic stage; pN, pathologic lymph node staging; ChT, chemotherapy; BEP, bleomycin, etoposide, cisplatin. *After systemic relapse in pN + patients, standard chemotherapy is indicated
See this image and copyright information in PMC

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