Surgery after chemotherapy
After courses of chemotherapy, a residual formation of more than 1 cm in the retroperitoneal space with normal markers must be removed: in 40–45% it is a mature teratoma capable of growing and becoming malignant, in 10–15% it is a viable tumor requiring additional chemotherapy, in 40–50% it is necrosis. Laparoscopically, the surgeon removes the formation along with lymphatic tissue within the boundaries of the template, separating it from the aorta, vena cava, and ureter; If there is a tight fusion with the vessels, a transition to open surgery is possible. Histology determines further tactics. For patients with preserved ejaculation, cryopreservation of sperm before surgery is recommended.
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.
