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Meta-Analysis
. 2024 Jul-Aug;50(4):415-432.
doi: 10.1590/S1677-5538.IBJU.2024.0134.

Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis

Bárbara Vieira Lima Aguiar Melão  1 , Lucas Guimarães Campos Roriz de Amorim  2 , Murilo Ribeiro Sanches  3 , Giovanna Veiga Gomes  4 , Douglas Mesadri Gewehr  5 , Luis Henrique de Oliveira Moreira  6 , Thaise Pedreira da Silva  7 , Matheus de Melo Lobo  8 , Gustavo Ruschi Bechara  9
Affiliations
Meta-Analysis

Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis

Bárbara Vieira Lima Aguiar Melão et al. Int Braz J Urol. 2024 Jul-Aug.

Abstract

Introduction: Chemotherapy and radiation therapy are considered standard treatments for stage II seminoma patients; however, these therapies are associated with long-term toxicities. Recently, retroperitoneal lymph node dissection has emerged as an alternative strategy, and the first three phase II trials were published in 2023 with promising results. The present study conducted a systematic review and meta-analysis to evaluate this surgery as an alternative treatment for stage IIA/B seminoma patients.

Purpose: Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition.

Methods: We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated.

Results: Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%.

Conclusions: Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.

Keywords: Male Germ Cell Tumor [Supplementary Concept]; Seminoma; Testicular Neoplasms.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. - PRISMA flow diagram of study screening and selection.
Figure 2
Figure 2. - Meta-analysis of primary endpoints after primary RPLND in patients with CS IIA/B testicular seminoma.
Figure 3
Figure 3. Meta-analysis of secondary endpoints after primary RPLND in patients with CS IIA/B testicular seminoma.
See this image and copyright information in PMC

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