Functional and oncological outcome of primary nerve sparing retroperitoneal lymph node dissection in marker negative testicular germ cell tumors in clinical stage IIA/B.

641 Background: Guideline recommended treatment of choice for clinical stage IIA/B testicular nonseminomatous germ cell tumors (NSGCT) is the delivery of chemotherapy with 3 cycles PEB, 4 cycles PE. Despite its high curative efficacy, chemotherapy is associated with significant long-term toxicities. We evaluated the functional and oncological outcome of primary nerve sparing retroperitoneal lymph node dissection in marker negative NSGCT as a therapeutic option. Methods: Between 2018-2024 49 patients underwent primary RPLND for marker negative clinical stage IIA/B testicular germ cell tumors. All patients underwent nerve-sparing RPLND with a unilateral or bilateral template dissection. None of the patients received adjuvant chemotherapy. Follow-up was performed according to the EAU guidelines. The surgeries were performed by a single surgeon using an open transperitoneal approach. Results: The median age and median follow-up were 30.1 (17-35) years and 29.4 (11-47) months, respectively. The mean operative time, blood loss, and hospitalization duration were 131 (105-195) minutes, < 150ml, and 4.5 (3-9) days, respectively. 10 patients (9.18%) experienced a Clavien-Dindo grade 3a complication. Antegrade ejaculation was preserved in 90.8% of cases. On average, 21 (7-42) lymph nodes were dissected. 5 patients exhibited teratomatous elements in the primary orchiectomy specimens and 4 patients demonstrated teratomatous elements in the resected lymph nodes. The mean number of positive lymph nodes was 2 (1-3), with an average size of 1.3 (0.3-3.0) cm. Ten patients (20.4%) showed a pN0 stage. Six patients (12.2%) developed a recurrence and were cured by salvage chemotherapy. Conclusions: Primary RPLND for marker negative clinical stage II/ABnonseminomatous germ cell tumors results in a high cure rate without additional chemotherapy and it is associated with a low rate of complications if performed in experienced hands. Additionally, nsRPLND can safe unnecessary cytotoxic systemic therapy in 20% of patients. Furthermore, 8.1% of patients with teratoma containing lymph nodes would not have been cured by chemotherapy. Primary nsRPLND should be included in the management of marker negative CS IIA/B NSGCT.