Retroperitoneal relapse after RPLND

Although tumor recurrence in the retro-peritoneum after RPLND is rare, unresected retroperitoneal disease appears to be an underestimated and, consequently, underreported phenomenon. There are several reasons that may explain this apparent discrepancy. First, the use of postoperative cisplatin-based chemotherapy may eliminate occult micrometastatic disease. Second, routine postoperative CT scanning is not routinely performed for follow-up after RPLND, with many centers relying on chest radiographs and serum tumor markers. Third, specifying sites of recurrence, particularly in the retroperitoneum, is often omitted in multiple reports. Finally, a better appreciation and understanding of late relapse suggests that prolonged follow-up will progressively unmask retroperitoneal failures in patients who underwent initial suboptimal RPLND [8,23-25].

With very rare exception, retroperitoneal recurrences after RPLND should always be considered surgical failures, whether they result from a technical error(s) or an inappropriately reduced template [24-26]. Donohue and colleagues [7] stated that ''.in many of these cases there was a relative lack of RPLND experience and/or resolve at the time of the initial procedure.'' Given the demographics of testicular cancer, the ''relative lack of RPLND experience'' is not surprising. Each year there are approximately 8500 new cases of testicular cancer diagnosed in the United States; and approximately 1200 RPLNDs are performed in over 100 urology residency programs (Residency Review Committee [RRC] 20002004). Indiana University and Memorial Sloan-Kettering Cancer Center (MSKCC) each perform over 100 RPLNDs per year and, according to statistics from the RRC of the American Board of Urology [27] for the years 2000 to 2004, urology residents averaged approximately five RPLNDs during their 4-year program (Table 1). These data are pertinent as there is emerging and compelling evidence from the urologic and general surgery literature that increased surgical volume

Table 1

Residency Review Committee. RPLND statistics for urology programs (2000-2004)

Table 1

Residency Review Committee. RPLND statistics for urology programs (2000-2004)

Year

Programs, n

Residents, n

RPLND, n

2000

106

229

1129

2001

106

232

1193

2002

104

223

1077

2003

109

234

1253

2004

108

229

1294

correlates with improved clinical outcome for many complex procedures [28-30].

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