It is important to remember that another treatment option, chemotherapy, results in total destruction of spermatogenesis for a variable period, usually 9 to 12 months. The return of good sperm quality takes close to a year and is unpredictable. The stage 1 patients were followed after surgery, and the stage 2 patients received adjuvant chemotherapy. All patients had no evidence of disease upon follow-up. If laparoscopic node dissections were failing to sample the nodes adequately, we would expect to see some relapses.
Laparoscopic procedures are tedious and lengthy, but they are an option.
Thus, surveillance offers the possibility of maintaining a high cure rate while avoiding the morbidity associated with immediate further treatment. Surveillance also presents some disadvantages. There is the potential for bulk relapse and an accompanying decrease in overall survival. If patients relapse, the total amount of chemotherapy required is higher than if the drugs were given preemptively. Based on this, researchers have debated which option presents the least cumulative morbidity.