1. DISEASE-SPECIFIC SURVIVAL AFTER 1 o RPLND MSKCC (n=453)

2. Low Stage NSGCT 1° RPLND provides the most accurate (N) catergorization curative in majority of patients with low volume (pN1) disease, and approximately 50% with high volume disease (pN2/3) no mortality; minimal morbidity antegrade ejaculation rates >95%

3. Low Stage NSGCT 1  RPLND “nerve-sparing” technique operation of choice surgical margins should not be compromised in an attempt to preserve ejaculation if positive nodes identified or suspected at time of RPLND, bilateral dissection recommended right modified template should include pre-and para-aortic nodes above IMA

4. RPLND Right Modified Templates B1

6. “Low Stage Testis Cancer Is Still Potentially Lethal” Swanson DA;J Urol 154:1376, 1995

7. 1  RPLND (laparoscopic or open) Making Curable Patients Incurable Modified templatesin pathologic stage II Omitting nodes dorsal to lumbar vessels J Urol 163: 1793, 2000 “retroaortic and retrocaval tissue not routinely removed” Urology 54: 1064, 1999 “prospectively, dissection was limited if grossly (+) nodes encountered” Urology 54:1064, 1999 Mean number of nodes 6.8 (5-9) Eur Urol 33: 190, 1998

8. Laparoscopic RPLND Pathologic Stage II AuthornBEPObserved Gerber, 19943 3(100%)ª 0 Janetschek, 1996 20 19(95%) 1* Bianchi, 1998 2 2(100%) 0 Kavoussi, 1999 12 10(83%) 2 LeBlanc, 2000 19 19(100%) 0 Total 56 53(95%) 3(5%) ª XRT – 1 patient * Retroperitoneal relapse

13. Laparoscopic RPLND Technically feasible staging procedure Steep learning curve Less morbidity in hands of dedicated experts It appears that more patients are exposed to potential toxicity of chemotherapy in low volume RP disease Therapeutic efficacy is unknown Therapeutic intent is unclear