Survivorship Post-Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer: A Systematic Review.

Introduction: Retroperitoneal lymph node dissection (RPLND) may be considered after chemotherapy or as primary treatment in patients with metastatic testicular cancer. We aimed to perform a systematic review to analyze outcomes in survivors across the domains of sexual, physical, and psychological function. It is the first systematic review of outcomes of survivorship following RPLND.

Methods: A systematic review was performed as per PRISMA guidelines. Outcomes were extracted from studies meeting the inclusion criteria and were analyzed.

Results: In total, there were 11 studies included with 1086 patients. Of these, 80.5% had stage 1 disease and 63.1% had nerve-sparing surgery. Clavien-Dindo 1-2 post-operative complications were reported in 14.1% of cases and Clavien-Dindo 3-5 in 4.5%. There was a 7.0% recurrence rate. Sexual impairment including hypospermia, dry ejaculation, and erectile dysfunction was more prevalent among patients who had non-nerve-sparing procedures. Primary robotic surgery was reported to decrease the systemic chemotherapy burden in patients. Physical, emotional, social functioning, and global quality of life were significantly better in minimally invasive surgery compared to open RPLND.

Conclusion: RPLND is a viable treatment approach and may be considered at multidisciplinary discussions for patients with metastatic testicular cancer. Minimally invasive surgery appears to have better sexual, physical, and psychological outcomes compared to open surgery, with low rates of perioperative complications and acceptable early oncologic outcomes. However, these patients may have been carefully selected and, therefore, are more likely to have favorable outcomes. Sexual dysfunction is a possible complication, and patients should be thoroughly counseled about the risks and benefits of RPLND.