Predictive Value of Tumor Burden for Oncologic and Functional Outcomes After Post-Chemotherapy Retroperitoneal Lymph Node Dissection

Objective: Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for residual masses is a technically demanding but potentially curative procedure. Our purpose is to describe the oncologic and functional outcomes of patients undergoing PC-RPLND at a referral center in Northeastern Mexico. Methods: A retrospective, correlational, and analytical study was conducted on 21 patients treated between January 2020 and April 2025. Demographic, surgical, and histopathological variables were analyzed using χ², Mann-Whitney U, Fisher’s exact tests, and Spearman’s correlations. Results: The mean age was 25.3 years (range 16-36). The most frequent clinical stage at surgery was IIIB (57.2%). Standard PC-RPLND was performed in 66.7%, salvage in 23.8%, and desperation in 9.5%. The open approach predominated (85.7%) with a mean operative time of 304 minutes. Complications occurred in 33.3%, mostly Clavien I, with no perioperative mortality. Complete remission was achieved in 76.2%, while recurrence occurred in 23.8%. Teratoma (55%) and necrosis (35%) were the most frequent histologies. The presence of viable malignancy increased the risk of recurrence by 31-fold (p < 0.001). Tumor size and volume correlated with greater vascular involvement (r = 0.73, p = 0.002) and complication severity (r = 0.56, p = 0.007). Masses larger than 10 cm were associated with a 90% rate of retrograde ejaculation. Conclusions: PC-RPLND provides adequate oncologic control with acceptable morbidity. Tumor size and viable malignancy remain the strongest predictors of recurrence and ejaculatory dysfunction in patients with post-chemotherapy residual masses.