Although RPLND is both a diagnostic and therapeutic procedure, it must be performed with therapeutic intent. Adequacy of initial RPLND is a prognostic variable for clinical outcome. Effective cisplatin-based chemotherapy will not reliably compensate for suboptimal initial surgery. Many patients undergoing either primary RPLND or PC-RPLND will have unresected extratemplate disease if modified templates are used. Anatomic mapping studies, which provided the basis for modified templates, have significant limitations. Teratomatous elements are often found in the retroperitoneum of patients requiring reoperative surgery, which can be performed with acceptable morbidity in tertiary centers with experienced surgeons. The integration of chemotherapy and reoperative surgery can result in survival rates of almost 70% in patients with retroperitoneal relapse after initial suboptimal RPLND.
