OBJECTIVES: To analyze whether primary metastatic spread occurs behind the lumbar vessels and whether removal is necessary for accurate staging in diagnostic retroperitoneal lymph node dissection, because dissection of lymphatic tissue behind the lumbar vessels is a challenging maneuver. METHODS: One hundred thirty-nine @entity1 were included in our study. Twenty-nine @entity1 with clinical Stage I @entity5 underwent laparoscopic staging lymph node dissection, including removal of the lymph nodes behind the lumbar vessels. Sixty-four @entity1 with @entity5 were retrospectively examined by computed tomography to determine the localization of the enlarged lymph nodes in relation to the lumbar vessels. On the basis of these results, 49 @entity1 with clinical Stage I underwent laparoscopic lymph node dissection within the same template but without dissection of the lymphatic tissue behind the lumbar vessels. RESULTS: In the first group, 10 of 29 @entity1 had pathologic @entity5 , with positive nodes exclusively ventral to the lumbar vessels. In group 2, 39 @entity1 with solitary metastatic lesions had enlarged lymph nodes, which were always ventral to the lumbar vessels. Only in 3 of 25 @entity1 with multiple @entity3 was one enlarged node found behind the lumbar vessels. In group 3, no @entity5 recurrence either before or behind the lumbar vessels could be found in 46 @entity1 after a mean follow-up of 27.8 months. CONCLUSIONS: On the basis of these data, we believe that primary lymphatic metastatic spread in @entity5 always occurs ventral to the lumbar vessels. Therefore, the removal of lymphatic tissue behind the lumbar vessels for diagnostic procedures is not necessary.

Primary lymphatic metastatic spread in XXXX occurs ventral to the lumbar vessels.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'Stage IIA tumors', 'testicular cancer', 'Stage II testicular cancer'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastases']
@entity5 :: (MESH:D009369,Disease) :: ['testicular cancer']
