EN-BLOC NEPHRECTOMY IN PATIENTS UNDERGOING POSTCHEMOTHERAPY RETROPERITONEAL LYMPH-NODE DISSECTION FOR NONSEMINOMATOUS TESTIS CANCER - INDICATIONS, IMPLICATIONS AND OUTCOMES

Purpose: We review the indications for nephrectomy at post-chemotherap y retroperitoneal lymph node dissection, identify patients at risk for nephrectomy and assess the impact of nephrectomy on outcome. Material s and Methods: Using a computerized data base and chart review we retr ospectively reviewed the records of 848 patients who underwent retrope ritoneal lymph node dissection after chemotherapy. Results: En bloc ne phrectomy was performed at retroperitoneal lymph node dissection after chemotherapy in 162 of the 848 patients (19%). The indications for ne phrectomy included contiguous involvement of perirenal structures in 7 3% of the cases, renal vein thrombosis in 6%, a poorly functioning or nonfunctioning renal unit in 5% and a combination of these conditions in 16%. Pathological studies of the hilum revealed cancer in 20% of th e eases, teratoma in 49% and fibrosis in 31%. Patients requiring nephr ectomy had significantly more advanced disease and larger disease volu me at presentation and after chemotherapy. There were no significant d ifferences in perioperative morbidity or mortality compared with patie nts who did not undergo nephrectomy. Only 3 patients required perioper ative dialysis and none required long-term renal support. Conclusions: These findings support en bloc nephrectomy at post-chemotherapy retro peritoneal lymph node dissection in select patients with large volume perihilar retroperitoneal disease.