%0 Journal Article
%T Primary Retroperitoneal Lymph Node Dissection as Treatment for Low-volume Metastatic Seminoma in a Population-based Cohort: The Swedish Norwegian Testicular Cancer Group Experience.
%A Thor A
%A Negaard HFS
%A Grenabo Bergdahl A
%A Almås B
%A Melsen Larsen S
%A Lundgren PO
%A Gerdtsson A
%A Halvorsen D
%A Johannsdottir B
%A Jansson AK
%A Hellström M
%A Wahlqvist R
%A Langberg CW
%A Hedlund A
%A Akre O
%A Glimelius I
%A Ståhl O
%A Haugnes HS
%A Cohn-Cedermark G
%A Kjellman A
%A Tandstad T
%J Eur Urol Open Sci
%V 65
%N 0
%D 2024 Jul
%M 38966804
%F 3
%R 10.1016/j.euros.2024.05.006
%X <B>UNASSIGNED: </B>There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy.<BR><B>UNASSIGNED: </B>Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS).<BR><B>UNASSIGNED: </B>In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13-24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16-30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4-14). PFS was 90% (95% confidence interval: 0.86-1) and OS was 100% at 24 mo.<BR><B>UNASSIGNED: </B>RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity.<BR><B>UNASSIGNED: </B>In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.