TESTICULAR TUMOURS - SURGICAL MANAGEMENT

Česká verzia

Authors: prim. MUDr. Ivan Pavlík; MUDr. Libor Šafařík, CSc.
Authors place of work: Urologická klinika 1. LF UK a VFN, Praha
Published in the journal: Urol List 2006; 4(3): 27-32

Summary

The objective of surgical treatment of testicular cancer is to examine or remove the tumorous mass suspicious for testicular cancer and to intervene in the retroperitoneum. It is applicable for stage 3 seminomas and stage 1 and 3 non-seminoma tumours in the diagnostic and therapeutic process.

Stage 3 seminomas are typical for the presence of lymphogenic metastases above the diaphragma or other distant metastases. Radiotherapy is used as complementary therapy only.

Three methods with the same final effect are currently used for the treatment of stage 1 non-seminoma tumours: watchful waiting, or surveillance, Retroperitoneal Lymph Node Dissection (RPLND) and adjuvant chemotherapy. Relapsing patients are treated with chemotherapy. Therapy of stage 2 non-seminoma patients involves RPLND, chemotherapy or the combination of the above two therapies. Therapeutic approaches vary: the preferred first-line treatment is either RPLND (e.g. USA), or chemotherapy (Europe), capable of inducing complete remission. The article further deals with different surgery techniques. The author concludes that laparoscopic RPLND is the appropriate surgery in the case of non-seminomatous germ cell tumours (NSGT) for its staging (stage 1) and should be preferred to open surgery for its low morbidity. The benefit of the surgery, especially in terms of its curative effect, has not yet been clearly determined for stage 2. Surgery for residual tumour after chemotherapy should be considered a risky but beneficial strategy to precise the staging; curative effect is possible in the case of vital tumour, yet another 2 to 4 cycles of adjuvant chemotherapy are recommended.

KEY WORDS:
testicular tumours, inguinal exploration, orchiectomy, preserving intervention, tumour resection, retroperitoneal lymphadenectomy, RPLND, surgery technique in RPLND, laparoscopic RPLND, NSGT

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