COMPLICATIONS OF POSTCHEMOTHERAPY RETROPERITONEAL LYMPH-NODE DISSECTION

The surgical morbidity rate of 603 patients who underwent lymphadenect omy after primary chemotherapy for clinical stages II and III testis c ancer from 1982 to 1992 was reviewed. There were 144 complications in 125 patients (20.7%). The majority of patients (93%) had a tumor volum e of greater than 5 cm. Five patients died 3 to 47 days postoperativel y, for an operative mortality rate of 0.8%. Pulmonary complications we re the most; frequent cause of severe morbidity: 6 patients had the ad ult 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 resec ted in these patients. Limiting inspired oxygen concentration and peri operative volume replacement are imperative to minimize bleomycin rela ted pulmonary morbidity. Additional procedures, such as nephrectomy an d colectomy, did not add to the morbidity rate. Among patients undergo ing concomitant venacavectomy there was a higher occurrence of postope rative chylous ascites. Most of the other complications (gastrointesti nal, lymphatic, neurological and renal) were temporary and treated con servatively. Perioperative management of the post-chemotherapy testis cancer patient is different from that of the patient undergoing primar y retroperitoneal lymphadenectomy. The latter operation is usually per formed in physically fit patients and the surgical template of dissect ion is of a smaller scale. Thus, the complications in this group are m inor and without mortality. Specific technical considerations and diff iculties are common to post-chemotherapy patients. Factors, such as la rge volume of disease, post-chemotherapy desmoplastic reaction and ext ensive retroperitoneal dissection, make these patients more prone to h ave complications. Decreased pulmonary, renal and nutritional reserves add to the surgical morbidity. Knowledge of possible pitfalls and the ir causes can avoid unnecessary operative complications.