Adjuvant surgery in testicular cancer patients undergoing postchemotherapy retroperitoneal lymph node dissection

Abstract

Purpose: To evaluate the clinicopathologic characteristics of patients undergoing adjuvant surgery during postchemotherapy retroperitoneal lymph node dissection (PC-RPLND).

Methods: From 2004 to 2010, 85 testicular cancer patients underwent PC-RPLND by a single surgeon (S.D.). A bilateral template approach was utilized with nerve-sparing technique whenever feasible. The clinicopathologic and outcome of patients who underwent removal of any organ or structure during PC-RPLND were reviewed.

Results: Of 85 patients undergoing PC-RPLND, 28 (33%) required adjuvant procedures. Thirteen (15%) required vascular procedures including cavotomy/caval resection in 6, aortic resection in 8, common iliac vessels resection in 4, and renal vessels resection/reimplant in 2. Twelve patients (14%) required adjuvant nephrectomy (ten of 12 left-sided). There was one ureteral resection with appendiceal substitution, one partial duodenectomy, two cholecystectomy, two thoracotomies, four liver resection/biopsy, and one neck dissection. There were eight early complications (28%), including vocal cord paralysis, brachial plexus injury, lower extremities compartment syndrome, thigh numbness, upper gastrointestinal bleeding, retroperitoneal hematoma, and alcohol withdrawal. No perioperative death was reported. Retroperitoneal pathology revealed mature teratoma in 11 patients (39%), fibrosis in 8 (28%), and viable germ cell tumor (GCT) in 9 (32%). A total of 75, 82, and 66% of patients with fibrosis, teratoma, and viable GCT, respectively, had no evidence of recurrence at a mean follow-up of 18 months.

Conclusions: Many patients undergoing PC-RPLND require adjuvant surgery, including vascular procedures and nephrectomy. The excellent outcomes associated with low operative morbidity and mortality validates such aggressive surgical approaches performed by experienced surgeons.