PURPOSE The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors with minimal late morbidity although little data exist on its efficacy in early metastatic seminoma. Surgery in early metastatic seminoma is a prospective phase II single-arm, multi-institutional trial of RPLND as first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy. PATIENTS AND METHODS Twelve sites in the United States and Canada prospectively enrolled adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm). Open RPLND was performed by certified surgeons with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. RESULTS A total of 55 patients were enrolled, with a median (IQR) largest clinical lymph node size of 1.6 cm (1.3-1.9). RPLND pathology demonstrated a median (IQR) largest lymph node size of 2.3 cm (0.9-3.5); nine patients (16%) were pN0, 12 (22%) pN1, 31 (56%) pN2, and 3 (5%) pN3. One patient received adjuvant chemotherapy. With a median (IQR) follow-up of 33 months (12.0-61.6), 12 patients experienced recurrence, with a 2-year RFS of 81% and a recurrence rate of 22%. Of the patients who experienced recurrence, 10 were treated with chemotherapy and two underwent additional surgery. At last follow-up, all patients who experienced a recurrence were disease-free and the 2-year overall survival was 100%. Four patients (7%) experienced short-term complications, and four patients experienced long-term complications including incisional hernia (1) and anejaculation (3). CONCLUSION RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.

中文翻译：

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早期转移性精原细胞瘤的手术：腹膜后淋巴结清扫术治疗伴有有限腹膜后淋巴结病的睾丸精原细胞瘤的 II 期试验。

目的化疗和放疗的长期毒性可能给睾丸癌幸存者带来重大负担。腹膜后淋巴结清扫术（RPLND）是睾丸生殖细胞肿瘤的一种既定治疗方法，尽管其治疗早期转移性精原细胞瘤的疗效数据很少，但晚期发病率极低。早期转移性精原细胞瘤手术是一项前瞻性 II 期单臂、多机构 RPLND 试验，作为治疗伴有临床小体积腹膜后淋巴结肿大的睾丸精原细胞瘤的一线治疗。患者和方法 美国和加拿大的 12 个研究中心前瞻性招募了患有睾丸精原细胞瘤和孤立性腹膜后淋巴结肿大 (1-3 cm) 的成年患者。开放式 RPLND 由经过认证的外科医生进行，主要终点为 2 年无复发生存期 (RFS)。评估了并发症发生率、病理分期上调/下调、复发模式、辅助治疗和无治疗生存期。结果 共有 55 名患者入组，中位（IQR）最大临床淋巴结大小为 1.6 cm（1.3-1.9）。RPLND 病理显示中位 (IQR) 最大淋巴结大小为 2.3 厘米 (0.9-3.5)；9 名患者（16%）为 pN0，12 名患者（22%）为 pN1，31 名患者（56%）为 pN2，3 名患者（5%）为 pN3。一名患者接受了辅助化疗。中位 (IQR) 随访 33 个月 (12.0-61.6)，12 名患者出现复发，2 年 RFS 为 81%，复发率为 22%。在复发的患者中，10 人接受了化疗，2 人接受了额外的手术。末次随访时，所有复发患者均无疾病，2年总生存率为100%。4 名患者 (7%) 出现短期并发症，4 名患者出现长期并发症，包括切口疝 (1) 和不射精 (3)。结论 RPLND 是治疗伴有临床小体积腹膜后淋巴结肿大的睾丸精原细胞瘤的一种治疗选择，且长期发病率较低。