Joel Sheinfeld MDab Pramod Sogani Md Facsab

aDepartment of Urology, Sidney Kimmel Center for Prostate and Urologie Cancers, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021, USA bDepartment of Urology, Weill College of Medicine, 525 East 68th Street, New York, NY 10021, USA

The management of patients with testicular cancer has evolved significantly over the past 25 years, largely as a result of the ability of cisplatin-based chemotherapy to cure advanced disease [1]. The appropriate integration of systemic chemotherapy and surgery has resulted in overall survival rates greater than 90% for patients with testicular cancer [2].

Retroperitoneal lymph node dissection (RPLND) remains a critical component in the management of germ-cell tumor (GCT) in both the primary and post-chemotherapy setting; and when properly performed, is a therapeutic procedure and not limited to diagnosis and staging [3,4]. Unfortunately, some patients will relapse in the retroperitoneum after RPLND and require reoperative retroperitoneal surgery. Emerging data on patients suffering late relapse and/or requiring reoperative retroperitoneal surgery clearly indicate that the liberal use of effective cisplatin-based chemotherapy will not compensate for inadequate initial surgery [3,5,6]. Therefore, surgical margins and templates should not be compromised in an attempt to preserve ejaculation. Complete surgical resection of metastatic retroperitoneal disease has been shown to be a significant and independent variable in relapse-free survival for patients with both low-stage and advanced nonseminomatous germ-cell tumor (NSGCT) [3,7].

This article will describe the clinical presentation, disease sites, histologic findings, and

* Corresponding author. Department of Urology, Sidney Kimmel Center for Prostate and Urologie Cancers, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021.

E-mail address: [email protected] (J. Sheinfeld).

postoperative morbidity for patients undergoing reoperative retroperitoneal surgery. In addition, the clinical outcome and possible etiologies for retroperitoneal recurrences are discussed.

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