VASCULAR INTERVENTIONS DURING POSTCHEMOTHERAPY RETROPERITONEAL LYMPH-NODE DISSECTION FOR METASTATIC TESTIS CANCER

Aims: Complete excision of nodal masses during post-chemotherapy retro peritoneal lymph-node dissection (RPLND) for metastatic non-seminomato us germ-cell tumours (NSGCT) of the testis often requires vascular sur gical intervention. We report our experience of vascular interventions and complications in a large series of men undergoing post-chemothera py RPLND. Methods: A retrospective review of vascular interventions du ring post-chemotherapy RPLND in 98 patients was undertaken (103 proced ures). Results: Macroscopic tumour clearance was complete in 95/98 men (97%). Vascular intervention was required in all cases. Major complic ations included acute tubular necrosis in one patient who had undergon e left nephrectomy and extensive dissection around the right renal art ery, progressive atrophy of the ipsilateral kidney in three men and a colonic stricture and associated colocutaneous fistula in one patient after division of the inferior mesenteric artery. Iliac and femoral ve nous thrombosis developed in both patients in whom the inferior vena c ava (IVC) was excised and in one patient after partial IVC excision. E ight of the 98 patients have died. No late vascular complications have occurred to date. Conclusion: Complete tumour clearance can be achiev ed in most post-chemotherapy RPLNDs but invariably involves vascular i ntervention. Metastatic NSGCT should be treated by surgeons with the a bility to undertake the vascular procedures required.