Complications of retroperitoneal lymph node dissection in testicular cancer: Primary and post-chemotherapy

Abstract

Retroperitoneal lymph node dissection (RPLND) is utilized in low‐stage testis cancer as a primary diagnostic and therapeutic procedure. In the post‐chemotherapy setting, it serves as an adjuvant procedure to resect residual tumor. Primary RPLND entails minimal resection of lymphatic tissue in the retroperitoneum; the complications are minor and insignificant. Wound infection is the main complication, affecting less than 5% of patients. Atelectasis and small bowel obstruction may occur in less than 2% of patients. In post‐chemotherapy RPLND, the template and the surgical challenge are much larger. Extensive tumor size, difficult location, adherence to major vessels, and vital structures, together with inferior pre‐operative status, are probably the main reasons for complications. The overall complication rate is 20% to 35% and mortality is 0.8% to 1%. Pulmonary insufficiency secondary to bleomycin‐induced interstitial fibrosis is the cause of the most severe side effects and mortality in these operations. Chylous ascites may occur, especially where resection of the inferior vena cava is necessary. Other complications occur to a lesser extent. A summary of all complications is presented and measures to avoid or manage them are depicted. Semin. Surg. Oncol. 17:263–267, 1999. © 1999 Wiley‐Liss, Inc.

Outcomes following retroperitoneal lymph node dissection in postchemotherapy residual masses in advanced testicular germ cell tumors

“…The complication rates for postchemotherapy surgery are higher than that for primary RPLND. [ 18 ] In our series, the complication rate was 37.1% that compares well with the reported rates of 20-35% in various series. [ 18 19 ] Most of the complications were of Clavien grade I and II, which included blood transfusion, postoperative fever, superficial wound infection, and paralytic ileus.…”

“…[ 18 ] In our series, the complication rate was 37.1% that compares well with the reported rates of 20-35% in various series. [ 18 19 ] Most of the complications were of Clavien grade I and II, which included blood transfusion, postoperative fever, superficial wound infection, and paralytic ileus. The higher complication rate in our series is attributed to the advanced stage of presentation, bulky retroperitoneal disease, and high number of patients with salvage chemotherapy with severe desmoplastic reaction, all of which are known risk factors.…”

Contemporary retroperitoneal lymph node dissection ( RPLND ) for testis cancer in the UK – a national study

“…No patients died within 30 days and the highest reported Clavien–Dindo grade was IIIb with a frequency of 1.5%. This compares well with other contemporary series that show higher grade complications (Clavien–Dindo Grade III–IV) of 8.9% and overall complication rates of up to 9% . We acknowledge that there may have been variability in case selection, including the potential for a small number of men to have been deemed inoperable.…”

“…The published perioperative mortality from RPLND is ~1% . In 73.5% of men in the present series there were no postoperative complications.…”

Retroperitoneal lymph node dissection for metastatic germ cell tumours

“…24 Late recurrence (after two years) occurs in 2-5% of patients treated for testicular cancer and the prognosis in these patients is poor. 25,26 We have compared our results with previous studies (Table 4) and our major complication rate of 19% and mortality rate of 1.6% is comparable with these studies.…”