ObjectiveTo conduct a systematic review of the current literature to determine the current role of primary retroperitoneal lymph node dissection (RPLND) in stage II testicular seminoma and its associated oncological, functional and peri‐operative outcomes.Materials and MethodsA comprehensive literature search was conducted in Medline, Embase, and Scopus for publications from inception until November 2023. The systematic review was registered on PROSPERO (ID CRD42023449781), was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and utilised the Methodological Index for Non‐Randomised Studies (MINORS) tool.ResultsSix studies involving 385 patients were analysed, with 48.5% clinical stage IIA and 51.5% stage IIB seminomas. The patients’ mean (range) age was 37 (20–64) years. The median operation time was 187 min, median estimated blood loss was 150 mL and median length of hospital stay was 4 days. In all, 6.1% of patients developed complications that were greater or equal to Clavien–Dindo grade 3. Only four studies reported on anejaculation rate (median: 4.9%). Only one study had long‐term data, demonstrating a 92% 5‐year overall survival for stage IIA/B disease treated with RPLND. The remaining five studies had a median follow‐up of between 18.5 and 37 months and reported a mean recurrence rate of 15.6%. Most recurrences (78%) were not within the field of RPLND. Recurrence was associated with higher clinical and pathological lymph node stage, and metachronous or delayed development of retroperitoneal lymphadenopathy (initially stage I disease, as opposed to de novo stage IIA/B disease).DiscussionPrimary RPLND, performed by experienced surgeons, has good peri‐operative outcomes. Recurrence is more common than with standard treatment, but long‐term survival and functional data are limited, although promising.

中文翻译：

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II 期睾丸精原细胞瘤的原发性腹膜后淋巴结清扫术：系统评价


目的对现有文献进行系统评价，以确定原发性腹膜后淋巴结清扫术 （RPLND） 在 II 期睾丸精原细胞瘤中的作用及其相关的肿瘤学、功能和围手术期结局。材料和方法在 Medline、Embase 和 Scopus 中对从建库到 2023 年 11 月的出版物进行了全面的文献检索。系统评价在 PROSPERO （ID CRD42023449781） 上注册，根据系统评价和荟萃分析的首选报告项目 （PRISMA） 指南进行，并使用非随机研究方法学索引 （MINORS） 工具。结果共分析了 6 项研究，涉及 385 例患者，其中临床 IIA 期占 48.5%，IIB 期精原细胞瘤占 51.5%。患者的平均 （范围） 年龄为 37 （20-64） 岁。中位手术时间为 187 min，中位估计失血量为 150 mL，中位住院时间为 4 d。总共有 6.1% 的患者出现大于或等于 Clavien-Dindo 3 级的并发症。只有 4 项研究报告了射精率 （中位数： 4.9%）。只有一项研究有长期数据，表明接受 RPLND 治疗的 IIA/B 期疾病的 5 年总生存率为 92%。其余 5 项研究的中位随访时间为 18.5 至 37 个月，报告的平均复发率为 15.6%。大多数复发 （78%） 不在 RPLND 领域内。复发与较高的临床和病理淋巴结分期以及腹膜后淋巴结肿大的异时性或延迟发展相关 （最初的 I 期疾病，与新发的 IIA/B 期疾病相反）。讨论由经验丰富的外科医生进行的初次 RPLND 具有良好的围手术期结局。 复发比标准治疗更常见，但长期生存和功能数据有限，尽管有希望。