COMPLICATIONS OF PRIMARY RETROPERITONEAL LYMPH-NODE DISSECTION

The surgical morbidity in 478 patients who underwent primary retroperi toneal lymphadenectomy for clinical stages I and II nonseminomatous te sticular cancer from 1982 to 1992 was reviewed. There were 54 complica tions in 51 patients (10.6%) and no operative related mortality. Super ficial wound infection was the most frequent complication, comprising 45% of the total number of complications. Most major complications wer e related to small bowel obstruction and atelectasis. No complications caused permanent disability. The complication rate was less in patien ts who underwent a modified unilateral procedure (9.4%) than in those who underwent bilateral dissection (19.3%). Complications were signifi cantly less with procedures done during the latter 6 years of the stud y (1987 to 1992). The ejaculation rate of patients undergoing a nerve sparing procedure was 98%, which reflects the increase in experience g ained with the technique of nerve sparing modified unilateral dissecti on for early stage testicular cancer. This study reinforces the view t hat primary retroperitoneal lymph node dissection is an operation with minimal morbidity and no long-term effects. Furthermore, this study s erves as the basis for cost-benefit and risk-benefit analyses of prima ry retroperitoneal lymph node dissection in low stage testicular cance r, which can be set against surveillance and primary chemotherapy prog rams.