Perioperative surgical outcomes in patients with seminomatous germ cell tumours of the testis and metastases to retroperitoneal lymph nodes

Introduction. Despite the high sensitivity of seminomatous germ cell tumours to platinum-based chemotherapy, a substantial proportion of patients retain residual retroperitoneal tumour masses after induction therapy. Their presence necessitates retroperitoneal lymph node dissection (RPLND), which offers both diagnostic and therapeutic value. However, RPLND remains a technically demanding procedure with a high risk of complications, particularly in cases of bulky residual tumours and pronounced fibrosis.

Objective. To evaluate perioperative outcomes of surgical treatment in patients with seminomatous germ cell tumours of the testis and metastases to retroperitoneal lymph nodes.

Materials & methods. We performed a retrospective analysis of surgical outcomes in 60 patients with histologically confirmed seminoma and residual tumour after induction chemotherapy who underwent RPLND between 2004 and 2026. The following parameters were analysed: age, side of primary tumour, TNM clinical stage, serum tumour marker levels (AFP, β-hCG, LDH) before and after chemotherapy, chemotherapy regimens and number of lines, operative time, blood loss, need for extended resections and vascular reconstruction, intraand postoperative complications according to the Clavien–Dindo classification, histological composition of residual tissue (necrosis/fibrosis, teratoma, viable seminoma), and requirement for adjuvant therapy.

Results. Mean operative time was 240 minutes, and mean blood loss was 500 mL. Extended procedures requiring organ resection/removal or vascular reconstruction/resection were necessary in 20.0% (n = 12) of patients. Postoperative complications occurred in 13.3% (n = 8) of patients. Pathomorphological examination of residual tumour revealed complete response (necrosis) in 63.3% (n = 38), viable seminoma in 21.7% (n = 13), and mature teratoma (pure or in combination with necrosis) in 15.0% (n = 9) of patients. Adjuvant therapy was administered to 16.7% (n = 10) of patients.

Conclusion. RPLND for metastatic seminoma is a technically complex surgical procedure characterised by a high rate of extended operations and significant blood loss, underscoring the need for these procedures to be performed in specialised centres with advanced equipment and experienced surgeons. The decision to perform RPLND and determination of its extent should be based on the size and location of residual masses, imaging findings, and the patient's overall condition, given the high risk of intraoperative complications associated with bulky tumour masses.

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