Between January 1985 and December 1990, 208 consecutive patients underwent retroperitoneal lymphadenectomy (RPLND) for low-stage (negative imaging or retroperitoneal disease up to 3 cm) non-seminomatous germ cell testicular tumors. Before RPLND, patients were staged with computed tomography (CT) or magnetic resonance imaging (MRI) of abdomen and pelvis, alpha-fetoprotein (AFP) and beta submit of human chorionic gonadotropin (b-HCG) assay. Lymphangiography (LAG) was performed in 139 cases. Out of 208, 173 (83%) patients belonged to clinical stage I, 21 (10%) to clinical stage II-A (retroperitoneal disease up to 2 cm) and 14 (7%) to clinical stage ll-B (retroperitoneal disease from 2 to 3 cm). Before RPLND, serum markers AFP and b-HCG were pathological in 16 (9%) of 173 patients in clinical stage I, in 7 (33%) of 21 in clinical stage ll-A and in 6 (43%) of 14 in clinical stage ll-B < 3 cm. Retroperitoneal metastases were pathologically found in 46 (27%) of 173 patients in clinical stage I, in 15 (71%) of 21 in clinical stage ll-A and in all 14 clinical stage ll-B < 3 cm. As many as 31 (20%) of 157 in clinical stage I with negative markers and only 8 (57%) of 14 clinical stage II-A with negative markers had retroperitoneal metastases. The low reliability of clinical staging enforces RPLND as the most accurate staging procedure for marker negative clinical stage I and II-A patients.
Should Chemotherapy Replace Retroperitoneal Lymphadenectomy for Clinical Stage II Testicular Tumors?
