Original Articles: Testis Cancer: Complications of Post-Chemotherapy Retroperitoneal Lymph Node Dissection

Abstract

No AccessJournal of UrologyClinical Urology: Original Article1 Mar 1995Original Articles: Testis Cancer: Complications of Post-Chemotherapy Retroperitoneal Lymph Node Dissection J. Baniel, R.S. Foster, R.G. Rowland, R. Bihrle, and J.P. Donohue J. BanielJ. Baniel , R.S. FosterR.S. Foster , R.G. RowlandR.G. Rowland , R. BihrleR. Bihrle , and J.P. DonohueJ.P. Donohue View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)67616-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The surgical morbidity rate of 603 patients who underwent lymphadenectomy after primary chemotherapy for clinical stages II and III testis cancer from 1982 to 1992 was reviewed. There were 144 complications in 125 patients (20.7%). The majority of patients (93%) had a tumor volume of greater than 5 cm. Five patients died 3 to 47 days postoperatively, for an operative mortality rate of 0.8%. Pulmonary complications were the most frequent cause of severe morbidity: 6 patients had the adult respiratory distress syndrome and 5 needed prolonged ventilation. The underlying cause was a combination of bleomycin induced pulmonary toxicity, and large volume retroperitoneal and pulmonary disease resected in these patients. Limiting inspired oxygen concentration and perioperative volume replacement are imperative to minimize bleomycin related pulmonary morbidity. Additional procedures, such as nephrectomy and colectomy, did not add to the morbidity rate. Among patients undergoing concomitant venacavectomy there was a higher occurrence of postoperative chylous ascites. Most of the other complications (gastrointestinal, lymphatic, neurological and renal) were temporary and treated conservatively. Perioperative management of the post-chemotherapy testis cancer patient is different from that of the patient undergoing primary retroperitoneal lymphadenectomy. The latter operation is usually performed in physically fit patients and the surgical template of dissection is of a smaller scale. Thus, the complications in this group are minor and without mortality. Specific technical considerations and difficulties are common to post-chemotherapy patients. Factors, such as large volume of disease, post-chemotherapy desmoplastic reaction and extensive retroperitoneal dissection, make these patients more prone to have complications. Decreased pulmonary, renal and nutritional reserves add to the surgical morbidity. Knowledge of possible pitfalls and their causes can avoid unnecessary operative complications. References 1 : Thoracoabdominal approach for retroperitoneal gland dissection: its application to testis tumors. Surg., Gynec. & Obst.1950; 90: 486. Google Scholar 2 : Retroperitoneal lymphadenectomy: the anterior approach including bilateral suprarenal-hilar dissection. Urol. Clin. N. Amer.1977; 4: 509. 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Crossref, Medline, Google Scholar From the Department of Urology, Indiana University Medical Center, Indianapolis, Indiana© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKern S, Cary C, Kaimakliotis H, Pedrosa J, Masterson T, Bihrle R, Foster R and Kesler K (2020) Surgical Management of Retrocrural Disease in Germ Cell Tumors: Outcomes and Evolution of PracticeJournal of Urology, VOL. 205, NO. 3, (812-819), Online publication date: 1-Mar-2021.Pedrosa J, Masterson T, Rice K, Bihrle R, Beck S and Foster R (2014) Reoperative Retroperitoneal Lymph Node Dissection for Metastatic Germ Cell Tumors: Analysis of Local Recurrence and Predictors of SurvivalJournal of Urology, VOL. 191, NO. 6, (1777-1782), Online publication date: 1-Jun-2014.Evans J, Spiess P, Kamat A, Wood C, Hernandez M, Pettaway C, Dinney C and Pisters L (2018) Chylous Ascites After Post-Chemotherapy Retroperitoneal Lymph Node Dissection: Review of the M. D. 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Volume 153Issue 3SMarch 1995Page: 976-980 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information J. Baniel More articles by this author R.S. Foster More articles by this author R.G. Rowland More articles by this author R. Bihrle More articles by this author J.P. Donohue More articles by this author Expand All Advertisement PDF downloadLoading ...