With the aim of enhancing surgical management, boosting long-term results, and reducing mortality rates in patients with testicular cancer, a recent study reveals that the traditional open surgery technique for removing lymph nodes located behind the intestines is the optimal treatment for men whose testicular cancer hasn’t progressed beyond the abdomen.
While it is significantly less common than breast or prostate cancers, testicular cancer is the leading solid tumor found in males aged 15 to 35, with about 10,000 young men receiving a diagnosis each year in the United States.
Conducted by urologist and health services researcher Clint Cary, M.D., MPH, MBA, from Indiana University School of Medicine and the Regenstrief Institute, the research shows that the established open surgery method for lymph node removal is considered the best standard of care for men facing this issue, given that their cancer is still within the abdominal area.
This surgical method entails making an incision in the abdomen to provide a clear view and access to the surgical site. For suitable patients, the success rates for curing cancer are very high, thanks to the ongoing expertise and improved techniques of clinicians, particularly at facilities that handle a large number of cases.
The study utilized data from the Indiana University Testicular Cancer database, analyzing cases from 165 patients diagnosed with clinical stage I or II testicular cancer who had not undergone chemotherapy before. The IU School of Medicine’s Department of Urology, recognized as one of the leading testicular cancer treatment centers in the U.S., aims for improved surgical results and reduced adverse outcomes like infertility. Key metrics for the study included minimal blood loss, short hospital stays, and infrequent significant postoperative issues.
Dr. Cary emphasizes that the findings suggest men and their families should engage in discussions with their local urologists about their experience levels concerning risk factors like high body mass index (BMI), along with a thorough review of complication rates. These results can serve both patients and healthcare providers as a benchmark for decision-making.
“In my role at Indiana University, I often conduct lymph node dissections for men with minimal metastatic cancer who have not received or may never require chemotherapy for this condition. As a researcher at the Regenstrief Institute, I examine the implications of clinical choices,” stated Dr. Cary. “This study aims to assess the impact of the treatments I administer on patient outcomes and quality of life, whether we continue with currently established methods or introduce innovative surgical approaches.”
“This research exemplifies how the integration of clinical care and research allows us to gain meaningful insights that benefit both patients and medical professionals. We continually strive to enhance surgical outcomes. Looking ahead, we are planning a randomized trial to compare two surgical techniques for lymph node removal to determine if one method offers better postoperative recovery than the other.”
The study did not include a comparison between robotic-assisted surgery and traditional open surgery, which could facilitate more comprehensive lymph node removal. Although robotic surgery may have advantages for both patients and surgeons, the authors acknowledge that direct comparisons between these two techniques are limited due to the small volume of robotic surgeries performed for testicular cancer.
The authors conclude that for patients undergoing lymph node removal for testicular cancer, especially those who are more complex or at greater risk for complications post-surgery, the traditional open surgery technique is still the most effective and remains the gold standard.
“Contemporary short-term peri-operative outcomes of open primary retroperitoneal lymph node dissection” has been published in BJU International. The study received support from the Department of Urology at IU School of Medicine, with Dr. Cary serving as the principal investigator.
The authors of the paper include Jacob D McFadden1, Timothy A Masterson1, and Clint Cary1, all from the Department of Urology, Indiana University School of Medicine.
