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Testicular cancer is the most common solid malignancy in men 20–40 years old, notably with a slowly increasing prevalence. The survival rate associated with non-seminomatous germ cell tumors (NSGCT) has seen a dramatic improvement over the past several decades. This improvement in survival has been largely attributed to a multidisciplinary approach that includes cisplatin-based chemotherapies and surgical advances in retroperitoneal lymph node dissection (RPLND). While most urologists are comfortable operating in the retroperitoneum and despite the pathologic staging and treatment benefits demonstrated by the RPLND, it remains a technically challenging surgery with a high potential for risk and morbidity even in the most skilled hands. These challenges are especially pronounced in the post-chemotherapy setting due to severe desmoplasia. Therefore, it should be performed by experienced surgeons at high volume centers. Surgeons attempting this surgery should possess a detailed knowledge of retroperitoneal anatomy, lymphatic drainage and associated metastatic pattern, and ability to troubleshoot potential complications should they arise as these are of paramount importance for success of this operation. Laparoscopic and robotic surgical approaches have been gaining traction and are useful for pathologic staging, but there is still insufficient evidence to support these modalities for curative intent. In this review we detail the surgical principles of

ame medical journal

A narrative review of the surgical principles of primary and post- chemotherapy retroperitoneal lymph node dissection for non- seminomatous germ cell tumors