Nerve sparing post-chemotherapy retroperitoneal lymph node dissection for advanced testicular cancer

Christopher L. Coogan, Mohamed J. Hejase, Gregory R. Wahle, Richard S. Foster, Randall G. Rowland, Richard Bihrle, John P. Donohue

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Purpose: Nerve sparing techniques are used routinely during retroperitoneal lymph node dissection in patients with low stage testis cancer in an attempt to preserve postoperative ejaculation. Preservation of ejaculation without an increased retroperitoneal recurrence rate in such patients prompted us to reevaluate the role of nerve sparing techniques in select patients undergoing post-chemotherapy retroperitoneal lymph node dissection. Materials and Methods: Of 472 patients who underwent post- chemotherapy retroperitoneal lymph node dissection between March 1988 and January 1995, 93 (19.7%) underwent a nerve sparing procedure. Two patients died of disseminated cancer within 6 months after postchemotherapy retroperitoneal lymph node dissection. In 10 patients the ejaculatory status could not be established from the clinical notes and the patient was lost to followup. The remaining 81 patients form the basis of this report. Disease status, complications and ejaculatory status were evaluated. Mean followup was 35.5 months. Results: Of the patients 76.5% reported normal ejaculation after post-chemotherapy retroperitoneal lymph node dissection. Testis cancer recurred after nerve sparing surgery in 6 patients but no tumor was retroperitoneal. Ten pregnancies have been reported to date with uneventful term deliveries in 7. Conclusions: Select patients are candidates for nerve sparing post-chemotherapy retroperitoneal lymph node dissection. Although indications for nerve sparing techniques in the postchemotherapy population have expanded, the local recurrence rate has not increased. Nerve sparing post-chemotherapy retroperitoneal lymph node dissection can preserve the inherent fertility potential of the patient without increasing retroperitoneal relapse rates.

Original languageEnglish (US)
Pages (from-to)1656-1658
Number of pages3
JournalJournal of Urology
Volume156
Issue number5
DOIs
StatePublished - Nov 1996

Keywords

  • ejaculation
  • infertility
  • lymph node excision
  • male
  • nerves
  • testicular neoplasms

ASJC Scopus subject areas

  • Urology

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