• Retroperitoneal lymph node dissection (RPLND) is gaining recognition as an effective treatment option for stage IIA/B seminoma, potentially avoiding long-term toxicities of chemotherapy or radiotherapy.
• Mapping studies in non-seminomatous germ cell tumors have refined RPLND techniques, emphasizing ipsilateral gonadal vessel resection and minimizing suprahilar dissection.
• Recent trials (SEMS, PRIMETEST, COTRIMS) demonstrate favorable survival outcomes with primary RPLND, though recurrence patterns vary, suggesting the need for tailored surgical approaches.
• Emerging data suggest that bilateral template dissections may improve survival outcomes compared to unilateral templates in specific patient subgroups with metastatic seminoma.