Primary Vs. Postchemotherapy Retroperitoneal Lymph Node Dissection For Germ Cell And Testicular Cancer: Inter-and Postoperative Complications

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 15 Jun 2008 - 6:00 PDT

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ORLANDO, FL (UroToday.com) - The authors examined their series of 216 patients with testis cancer who underwent retroperitoneal lymph node dissection (RPLND). 117 patients had primary-RPLND (P-RPLND), while 99 patients were subjected to post-chemotherapy dissections (PC-RPLND). The authors compared clinical data from the P-RPLND group and the PC-RPLND patients. Blood loss was higher in the PC-RPLND group (1,500 cc vs 600 cc, p<0.0001). PC-RPLNDs was also a longer operation (353 minutes vs 279 minutes, p<0.0001). No statistical difference was seen in major vascular injuries (those requiring intraoperative consultation with a vascular surgeon) in the PC-RPLND group (n=11) when compared to the P-RPLND patients (n=6). The authors used a grading scale to classify complications that occurred intraoperatively or within 30 days of surgery:

Grade I - medical management
Grade III - procedure or re-operation needed
Grade IV - chronic disability
Grade V - death

37% of patients who underwent PC-RPLND and 27% of patients following P-RPLND experienced some type of complication. Unlike reports by other groups, this difference did not reach statistical significance. Patients in the PC-RPLND group were more likely to have a non-Grade I complication. Subdivision of complications by grade was as follows:

I Grade P-RPLND 25 (64%) - PC-RPLND 30 (57%)
II Grade P-RPLND 9 (23%) - PC-RPLND 16 (31%)
III Grade P-RPLND 5 (13%) - PC-RPLND 4 (8%)
IV Grade P-RPLND 0 (0%) - PC-RPLND 1 (2%)
V Grade P-RPLND 0 (0%) - PC-RPLND 1 (2%)

Reports such as this from centers that perform high volumes of these difficult and rare operations are very valuable to the urological community at large.

Presented by Vairavan S Subramanian, MD, Carvell T Nguyen, MD, Andrew J Stephenson, MD, and Eric A Klein, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Alexander Kutikov, MD

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