eMedicine Specialties > Urology > Cancer, Testicle

Nonseminomatous Testicular Tumors: Follow-up

Author: David M Hoenig, MD, Associate Professor, Department of Urology, Albert Einstein College of Medicine; Chief of Weiler Division, Director of Laparoscopy and Endourology, Co-Director of Fellowship in Laparoscopy and Endourology, Residency Program Director, Department of Urology, Montefiore Medical Center
Coauthor(s): Janice Angela Santos-Cortes, MD, Chief Resident, Department of Urology, Albert Einstein Program, Montefiore Medical Center; Thomas H Rechtschaffen, MD, Consulting Staff, Department of Urology, A Family Urology Practice, PC
Contributor Information and Disclosures

Updated: Sep 28, 2009

Outcome and Prognosis

Patients with stage I disease typically achieve a 98% disease-free survival rate at 5 years.

Patients with stage IIA and IIB disease typically achieve a 92% disease-free survival rate at 5.5 years.

Patients with stage IIC disease can expect an approximately 92% overall survival rate at 5 years.

Patients with stage III disease classified as low-risk have a 92% overall survival rate at 5 years. Intermediate-risk patients have an 80% overall survival rate at 5 years. High-risk patients have a 48% overall survival rate at 5 years.

Future and Controversies

Laparoscopic retroperitoneal lymph node dissection

The long-term adverse effects of RPLND can be diminished by limiting the dissection in appropriate patients. The short-term adverse effects associated with an extensive dissection include a long postoperative hospital stay, significant pain, and a protracted period before the patient can resume normal work and leisure activities.

Some of these disadvantages can be mitigated with a relatively new surgical approach that involves making several small incisions to admit an operative telescope and miniature surgical instruments to accomplish the same surgery as in the traditional, large, single-incision procedure. The advantages of laparoscopic surgery are observed primarily in the postoperative setting, with a shorter hospital stay, decreased pain, and faster convalescence.

Several series on the application of laparoscopic RPLND in patients with clinical stage I nonseminomatous germ cell tumors (NSGCTs) have already been reported in the literature, with promising results.

One such series reported on 73 laparoscopic RPLNDs for clinical stage I NSGCT. Twenty-six percent of the patients had pathological stage II disease, and they all received 2 cycles of adjuvant chemotherapy. All patients with stage I disease (mean follow-up of 43.3 mo) and stage II disease (mean follow-up of 42.7 mo) were free of disease. Ejaculation was preserved in all 70 patients after an adequate follow-up period. The conversion rate from laparoscopic to open RPLND was only 2.7% (2 of 73 cases). The mean operative time was prolonged (297 min); however, the time improved dramatically with experience.21

The laparoscopic approach to RPLND has been further refined in recent years, and longer-term follow-up studies have suggested that this approach may be an acceptable alternative to traditional RPLND in select patients. Neyer et al (2007) reported on 136 patients who underwent laparoscopic RPLND, with 94% of patients remaining relapse-free after a mean follow-up of 68 months.22

The role of RPLND following chemotherapy is controversial. In general, all patients with a residual retroperitoneal mass require RPLND. However, virtually all patients in whom the mass resolves completely or reduces in volume by more than 90% will develop necrosis and fibrosis only, conceivably eliminating the need for RPLND.

Postchemotherapy RPLND is a much more complicated procedure and may be critical to achieving cure. Shayegan et al (2007) reported that, even in high-risk patients, long-term freedom from disease progression is best achieved with a combination of chemotherapy and resection of residual masses, with an 81% disease-specific survival rate and a 70% likelihood of no progression.23 In this study, multivariate analyses suggest that residual tumor mass, incomplete surgical resection, and the presence of teratoma and viable tumor all independently predicted disease progression after RPLND.

Postchemotherapy laparoscopic RPLND, while initially fraught with significant intraoperative and postoperative morbidities, continues to be explored, with improving results. In a single-surgeon experience, a recent retrospective study of 16 patients showed successful performance of the laparoscopic RPLND in 14 of 16 patients and a dramatic decrease in complications as experience was gained.24 However, further experience is needed before this procedure can be considered routine.

 


More on Nonseminomatous Testicular Tumors

Overview: Nonseminomatous Testicular Tumors
Workup: Nonseminomatous Testicular Tumors
Treatment: Nonseminomatous Testicular Tumors
Follow-up: Nonseminomatous Testicular Tumors
References
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Further Reading

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Keywords

testicular tumor, nonseminomatous testicular tumor, testis cancer, testicular cancer, testis mass, testicular mass, nonseminomatous germ cell tumor, non-seminomatous germ cell tumor, non-seminoma germ cell tumor, nonseminoma germ cell tumor, NSGCT, nonseminomatous germ cell testicular tumor, nonseminomatous testicular germ cell tumor, NSGCTT, NSTGCT, seminoma, nonseminoma, embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumor, cryptorchidism, testicular trauma, mumps orchitis, gynecomastia, orchiectomy

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Contributor Information and Disclosures

Author

David M Hoenig, MD, Associate Professor, Department of Urology, Albert Einstein College of Medicine; Chief of Weiler Division, Director of Laparoscopy and Endourology, Co-Director of Fellowship in Laparoscopy and Endourology, Residency Program Director, Department of Urology, Montefiore Medical Center
David M Hoenig, MD is a member of the following medical societies: American Urological Association and Endourological Society
Disclosure: Boston Scientific Grant/research funds Consulting; Endocare Consulting fee Speaking and teaching; Applied Medical Consulting fee Speaking and teaching

Coauthor(s)

Janice Angela Santos-Cortes, MD, Chief Resident, Department of Urology, Albert Einstein Program, Montefiore Medical Center
Janice Angela Santos-Cortes, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Thomas H Rechtschaffen, MD, Consulting Staff, Department of Urology, A Family Urology Practice, PC
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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