目的 原发性腹腔后淋巴结清扫手术的主要治疗目的是对有淋巴结阳性的纯精原细胞瘤进行精确分期与治疗，同时避免长期使用化疗或放疗等传统的标准治疗方式带来的风险。本研究旨在通过回顾性的单中心病例系列研究，报告接受原发性腹腔后淋巴结清扫手术治疗的纯精原细胞瘤患者的病理学及肿瘤学结果，并以辅助治疗策略（随访与辅助化疗）为分层标准，评估两年无复发生存率作为主要临床结果。方法 经鉴定，共有45名转移至腹腔后淋巴结的纯睾丸精原细胞瘤患者接受了原发性腹腔后淋巴结清扫手术。在手术前，最大淋巴结的中位数大小为1.8cm。其中96%的患者（n=43）病理学检查显示存在活跃的生殖细胞瘤，全部为纯精原细胞瘤。积极的淋巴结的中位数及全部切除的淋巴结的中位数分别为2和54。积极病理学检查的淋巴结大小的中位数为2cm（IQR 1.4-2.5 cm，范围0.1-5cm）。在术后随访期间，29名患者中有4名复发，两年无复发生存率为81%。在未复发的随访患者中，中位随访时间为18.5个月。在腹腔内未见到复发，亦无内脏复发或死亡情况。16名接受辅助治疗的患者中，有1名在盆腔复发，复发发生于19个月后。结论 原发性腹腔后淋巴结清扫手术对于转移量较低的纯精原细胞瘤患者来说是安全有效的，使大多数患者能够避免长期化疗或放疗所带来的毒副作用。

Primary surgical treatment with retroperitoneal lymph node dissection aims to accurately stage and treat patients with node-positive pure seminoma while avoiding long-term risks of chemotherapy or radiation, traditional standard-of-care treatments.We reported the pathologic and oncologic outcomes of patients with pure seminoma treated with primary retroperitoneal lymph node dissection in a retrospective, single-institution case series over 10 years. The primary outcome was two-year recurrence-free survival stratified by adjuvant management strategy (surveillance versus adjuvant chemotherapy).Forty-five patients treated with primary retroperitoneal lymph node dissection for pure testicular seminoma metastatic to the retroperitoneum were identified. Median size of largest lymph node before surgery was 1.8 cm. Viable germ cell tumor, all of which was pure seminoma, was found in 96% (n=43) of patients. The median number of positive nodes and nodes removed was 2 and 54, respectively. Median positive pathologic node size was 2 cm (IQR 1.4-2.5 cm, range 0.1-5 cm). Four of 29 patients managed with post-operative surveillance experienced relapse; two-year recurrence-free survival was 81%. Median follow-up for those managed with surveillance who did not relapse was 18.5 months. There were no relapses in the retroperitoneum, visceral recurrences, or deaths. Among the 16 patients who received adjuvant treatment, 1 patient experienced relapse in the pelvis at 19 months.Primary retroperitoneal lymph node dissection for pure seminoma with low-volume metastases to the retroperitoneum is safe and effective, allowing most patients to avoid long-term toxicities from chemotherapy or radiation.