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This study explores the basis for providing effective access to electronic medical record data as a reference source for patients with early-stage testicular cancer undergoing surveillance follow-up programs.

Background: Testicular cancer is the most common malignancy in men aged 15-34, and its incidence has been increasing over the past half-century. Survival for stage I testis cancer approaches 100% regardless of management strategy which is often dictated by other factors such as perceived morbidity. Advances in treatment have attempted to decrease morbidity and surveillance is thought to achieve this goal., Methods: An English language literature search of MEDLINE from 1966 to December 2005 and CINAHL from 1982 to December 2005 was conducted using a broad search strategy. Comparative and descriptive original articles on outcomes of seminoma or NSGCT surveillance would be deemed eligible and review articles containing no original data were omitted. One hundred and thirty-eight articles were selected for formal review, during which a database was compiled that documented the first author, publication year, tumor histologic type, study purpose or topic(s), methodology, sample size, median follow-up, and relevant results., Results: Most evidence for the efficacy of surveillance is from descriptive series or non-experimental comparative studies. Relapse occurs in approximately 28% and 17% of surveillance patients in NSGCT and seminoma, respectively, and cause-specific survival is approximately 98% and 100%, respectively. Compliance with surveillance ranges from poor to adequate, however there is no evidence that compliance impacts clinical outcome. Cost analyses have yielded inconsistent results when comparing treatment modalities. There is scant literature on quality of life and psychosocial issues and results are inconsistent. Active surveillance appears to be appropriate and perhaps optimal first line management of clinical stage I seminoma and non-seminomatous germ cell tumors. Further quantitative and qualitative research is warranted to deepen understanding of these issues that may impact treatment decision-making.

Surgery for retroperitoneal nodal metastases of testicular germ-cell tumors has evolved considerably since its inception. Minimizing injury to sympathetic nerves has involved their exclusion from resection boundaries and/or "nerve sparing," by identifying and preserving nerves within the resection field. These measures improve long-term procedure-related morbidity with equivalent rates of cancer control. We believe that nerve-sparing techniques are the standard of care and enforce good principles of surgery by demanding attention to anatomy and exposure. Experience with this procedure, knowledge of retroperitoneal anatomy, and thoughtful clinical and surgical decision making are imperative to achieving acceptable results. It behooves urologic oncologists to offer patients maximal therapeutic benefit combined with minimal morbidity and that retroperitoneal lymphadenectomy should be nerve sparing by definition.