For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?   

There are few indications for primary RPLND in pure nonseminomatous CSI.  The only one I can currently think of is someone who has a strong contraindication to ever receiving chemotherapy.... renal failure or the like.  The only time I consider it general is for patients with high risk Ley...