Nerve-sparing technique in RPLND for testicular cancer.
| Autor: | Nalavenkata S; Department of Urology, Westmead Hospital, Westmead, and Faculty of Medicine and Health, University of Sydney, NSW, Australia., Li T, Patel MI |
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| Jazyk: | angličtina |
| Zdroj: | Current opinion in urology [Curr Opin Urol] 2023 Jul 01; Vol. 33 (4), pp. 281-287. Date of Electronic Publication: 2023 May 02. |
| DOI: | 10.1097/MOU.0000000000001100 |
| Abstrakt: | Purpose of Review: The management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND. Recent Findings: The standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity. Summary: RPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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