Introduction:

The Surgery in Early Metastatic Seminoma (SEMS) trial is a phase II, prospective multi-institutional surgical clinical trial that established retroperitoneal lymph node dissection (RPLND) as a potential first-line treatment in testicular seminoma with limited retroperitoneal lymphadenopathy.  Herein, we describe the surgical and functional outcomes of patients.

Methods:

Inclusion criteria was  testicular seminoma and no more than two enlarged lymph nodes between 1-3 cm in size. Surgical data from 12 enrolling sites in U.S. and Canada were reviewed and recorded (i.e. template, nerve sparing), including complications and ejaculatory function. Nerve-sparing approach was determined by operative reports and confirmed by an independent review of intra-operative photos.

Results:

The study consisted of 55 patients enrolled at 12 institutions with 19 different surgeons. All cases were performed via an open, midline approach. An average of 31 (IQR 18-40) lymph nodes were removed. Pathologic upstaging occurred in 49% of patients (Table 1) and 16% were downstaged to pN0. Of the 55 enrolled patients, 16% were pN0, 22% pN1, 56% pN2, and 6% pN3. Overall, the recurrence free survival at 2 years was 82% and overall survival was 100%. Four (7%) patients experienced five short-term complication, while 6 (11%) patients experienced a long-term complication. Nerve sparing was performed in 48 patients (87%). Of patients who underwent nerve sparing RPLND,  98% maintained antegrade ejaculation. Table 2 stratifies antegrade ejaculation rates based on surgical template. 

Conclusion:

In a contemporary prospective surgical trial across multiple institutions, the SEMS trial demonstrates RPLND for early stage seminoma is associated with a low complication rate and high rate of maintaining ejaculation.

Funding: Think Different Foundation