Before effective chemotherapy was developed most patients with localized testicular cancer underwent retroperitoneal lymph node dissection to diagnose unseen cancer and to remove cancerous lymph nodes. This resulted in surgery being performed on three-quarters of patients who don’t need it, as there is no benefit to the removal of lymph nodes uninvolved with cancer. With the development of effective chemotherapy to treat testicular cancer physicians have been evaluating the alternative of surveillance (careful periodic testing and examination) and treating those patients who develop recurrent disease with chemotherapy. In one study from Canada, 105 patients were managed in this fashion. Thirty-seven of the 105 patients relapsed (35%) and required therapy between 2 and 21 months after diagnosis. Thirty-six of the 37 were treated successfully. This study demonstrates the feasibility of this approach in patients who agree to close supervision and comply with the surveillance program. (Journal of Clinical Oncology, Vol 10, No. 4, pp 564-568, 1992)
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