MP33-04: The early results of the SWENOTECA (Swedish Norwegian Testicular Cancer Group) introduction of primary retroperitoneal lymph node dissection (RPLND) in seminoma stage IIA-IIb ≤ 3cm.
Introduction: Chemotherapy or radiotherapy have been the standard treatment for stage II seminomas with excellent results for survival but associated with significant long-term treatment-related toxicities. Several prospective trials have shown primary retroperitoneal lymph node dissection (RPLND) to be effective and safe as an alternative treatment. These results made us change the guidelines in the latest update of the SWENOTECA treatment program making surgery with RPLND the primary treatment modality in seminoma stage IIA to IIB = 3 cm with 1-2 metastatic nodes. We have done an update of the result of the patients treated by the new management program. Methods: The RPLND surgery in Sweden and Norway are centralised to 5 hospitals all participating in this study. In the study we included both patients with recurrence after initial stage I disease and patients with stage IIA and B at diagnosis. The patients were operated between 2019 and 2022. We collected information on operation time, bleeding, peri- and postoperative complications. We also analysed the histology and if adjuvant chemotherapy was given. We followed the patients for any recurrence of disease. Results: We have included 61 patients operated from January 2019 to September 2022. The number of operations per site varied from 4 to 22. The mean age of patients at time of RPLND was 42.6 years (range 25-79). 38 patients had stage I disease at diagnosis and a recurrence. 23 patients had stage IIA or IIB disease at diagnosis. At time of RPLND 46 patients had IIA-disease and 14 stage IIB-disease (one missing data). The histology from RPLND showed seminoma in 56 patients, necrosis in two patients, teratoma in one patient (two missing data). 24 patients were operated with robotic laparoscopic technique. Seven patients out of 61 had a Clavien-Dindo postoperative complication > 2. The patients have been followed for a median of 17 months (range 2-45). Five patients have had recurrences, three in operated template and two outside templates. Conclusions: Our early results of primary RPLND of seminomas IIA-IIB = 3 cm, show promising results. Longer follow-up is required to fully ensure that this is a safe treatment option. SOURCE OF Funding: None
