From the Guidelines
Retroperitoneal lymphadenopathy in a patient with testicular cancer should be managed with a retroperitoneal lymph node dissection (RPLND) as indicated by the European Association of Urology guidelines, particularly in cases with high-risk features such as lymphovascular invasion (LVI) or extranodal tumor extension 1. When considering the management of retroperitoneal lymphadenopathy, it is crucial to evaluate the patient's overall clinical stage and histological features of the testicular cancer.
- Key factors influencing the decision for RPLND include the presence of nodal metastases, primary pT stage, and histological features like predominant embryonal carcinoma or extranodal tumor extension.
- The procedure should ideally be performed by an experienced surgeon in a specialist center, with consideration for nerve-sparing techniques and minimally invasive approaches to reduce morbidity, as supported by recent guidelines 1.
- The patient's suitability for chemotherapy, potential for neuropathy, and other comorbidities should also be taken into account when deciding on upfront surgery versus other management strategies.
- Data from high-volume centers indicate that RPLND can result in relapse rates of 10% in cases of negative nodes and less than 30% in cases of nodal metastases, highlighting the importance of accurate staging and tailored treatment plans 1.
From the Research
Diagnosis and Imaging of Retroperitoneal Lymphadenopathy
- Retroperitoneal lymphadenopathy can be diagnosed using imaging methods such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) 2, 3, 4.
- MRI can detect retroperitoneal lymphadenopathy with a high degree of accuracy, especially when using a multislice spin-echo pulse sequence 3.
- PET-CT can detect small malignant nodes not identified by CT and can assess the extent of retroperitoneal malignancies 4.
Characteristics of Retroperitoneal Lymphadenopathy
- Retroperitoneal lymphadenopathy can be associated with various malignancies, including lymphoma, testicular cancer, and renal cell carcinoma 2, 4, 5.
- The presence of retroperitoneal lymphadenopathy can impact survival and response to immunotherapy in patients with metastatic renal cell carcinoma 5.
- Dilated retroperitoneal lymphatic channels can be visualized on CT and MRI, appearing as a meshwork of multiple tubular, tortuous, fluid-filled structures 6.
Treatment and Prognosis
- The treatment and prognosis of retroperitoneal lymphadenopathy depend on the underlying cause and extent of the disease 2, 5.
- Immunotherapy can improve survival in patients with metastatic renal cell carcinoma, but the presence of retroperitoneal lymphadenopathy can reduce the effectiveness of treatment 5.
- Surgical intervention and poly-chemotherapy can be effective in treating retroperitoneal lymphoma, as shown in a case study of a patient with non-Hodgkin lymphoma, Diffuse Large B-Cell Lymphoma (DLBCL) 2.