Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data

Abstract

were identified and perioperative data obtained. RESULTSOf the 190 patients who had RPLND, 98 (52%) and 92 (48%) had P-and PC-RPLND, respectively. Histology of the orchidectomy specimen consisted of embryonal carcinoma in 146 (76%) patients, also including lymphovascular invasion in 83 (44%). The mean (range) operative duration was 206 (110-475) min and the mean blood loss was 294 (50-7000) mL. The median hospital stay was 4 days. Mean blood loss, operative duration and hospital stay were significantly less for the P-RPLND than for PC-RPLND groups ( P < 0.05). There were 18 (9%) perioperative complications in all. There were no deaths in either group. CONCLUSIONSThe short-term morbidity of open RPLND is acceptable, and open RPLND is safe and effective at select tertiary centres. When compared with historical data, the present contemporary series shows that the operative duration, blood loss and hospital stay have improved, with few complications. These contemporary data should be considered when comparing laparoscopic with open RPLND.

Perioperative data for retroperitoneal lymph node dissection in patients with nonseminomatous testicular cancer: Retrospective analysis from a single institution

“…The fibrosis and desmoplastic reaction associated with the effect of platinum chemotherapy and the meticulous dissection required because of intrinsic anatomic relation of important structures accounts for the difficulty of PC-RPLND, including increased operative time, elevated blood loss and high rates of perioperative complications [14,15] . The introduction of both the modified-template RPLND, nerve-sparing and laparoscopic approaches has significantly decreased the morbidity associated with this procedure.…”

“…The introduction of both the modified-template RPLND, nerve-sparing and laparoscopic approaches has significantly decreased the morbidity associated with this procedure. However, these approaches have been indicated for selected low-risk patients with early stage tumors [6,14,15] . Even though current indications for RPLND remain controversial, it is still an established treatment modality in certain situations: in low-stage disease, the surgical removal of involved retroperitoneal lymph nodes may promote cure with surgical therapy alone, thereby avoiding chemotherapy; in post chemotherapy disease, surgical removal may be therapeutic and in more complicated post chemotherapy disease such as late relapse or the removal of chemoresistant retroperitoneal cancer (desperation RPLND), 30% to 40% of these patients with chemo-resistant metastatic cancer can be cured with surgical therapy alone [6] .…”

“…When compared to other series, we had a heterogeneous group of patients with different disease stages, which at first makes it difficult to compare with the literature [14] . Moreover, we had 4 cases of stage III patients, which have not been included in other series estimating perioperative morbidity [4,16] .…”

“…hemicolectomy, hepatectomy and nefrectomy) and lasted over 500 minutes (540, 615 min). It has been described that these post chemotherapy procedures can be technically challenging and may require diverse technical capabilities and a commitment to a sometimes lengthy and arduous procedure [6,14] . The main limitation of this study is the small number of patients, which makes it difficult to draw definitive conclusions.…”

The Role of Postchemotherapy Surgery in Germ Cell Tumors

“…[12][13][14] RPLND has developed from a procedure with limited long-term survival in the early 1900s 1 to the current state of limited mortality. 15 This advancement is due to improvement in operative techniques, such as limitation of suprahilar dissection, use of modified templates, and identification of hypogastric nerves. Optimization of perioperative care has also resulted in decreased morbidity.…”