The size of the primary tumors may be a prognostic factor, as the patients with tumors larger than 6 centimeters have a higher risk of relapse. If preservation of fertility is an important consideration, a surgical technique for sparing sympathetic ganglia and chains should be used. I patients and appears to be as effective as the standard RPL dissection. In patients with pathologic stage I disease after RPL, the presence of lymphatic or venous invasion in the primary tumor appears to predict for relapse. Retroperitoneal dissection of lymph nodes is not helpful in the management of children, and potential morbidity of the surgery is not justified by the information obtained.
Chemotherapy is employed immediately on first evidence of recurrence.
CT scan and serum markers are negative. Lymphangiography, when CT scan and serum markers are negative, does not appear to significantly add to patient management. The patient and physician accept the need for repeat CT scans as necessary to continue the periodic monitoring of the retroperitoneal lymph nodes. The patient will diligently follow a program of regular checkups for 2 years which includes history, physical examination, x-ray of abdominal lymph nodes, and determination of serum markers. Physician accepts responsibility for seeing that a follow-up schedule is maintained as noted for 2 years and then periodically beyond 2 years.