Precise stage instead of guessing
CT does not distinguish reactive nodes from metastatic ones when the size is less than 1–2 cm, and tumor markers are normal in a third of patients with micrometastases. Laparoscopically, the surgeon removes tissue with nodes according to a modified template on the side of the tumor (for right-sided testicular cancer - paracaval and interaortocaval, for left-sided - paraaortic), preserving the sympathetic nerves. Histology after 7–10 days determines: in the absence of metastases - observation without chemotherapy, if present - 2 courses of chemotherapy with a cure rate of more than 95%. Recovery 2–3 weeks.
The role of lymphadenectomy in testicular cancer
Testicular cancer metastasizes primarily to the retroperitoneal lymph nodes along the aorta. Retroperitoneal lymphadenectomy is performed: diagnostically - in stage I nonseminoma for accurate staging (micrometastases are found in 20-30%) as an alternative to chemotherapy and observation; therapeutically - for residual formations of more than 1 cm after chemotherapy (40% of them have a mature teratoma, 10-15% have an active tumor, which are not treated with chemotherapy). Laparoscopic access reduces trauma while maintaining radicality.
Preservation of ejaculation
The sympathetic nerves responsible for ejaculation pass through the surgical area; nerve-sparing techniques and modified templates allow maintaining antegrade ejaculation in 90–95% of patients. Sperm cryopreservation is recommended before surgery. Recovery after laparoscopy is 3–4 weeks.
