LONG-TERM RESULTS AFTER INFERIOR VENA-CAVAL RESECTION DURING RETROPERITONEAL LYMPHADENECTOMY FOR METASTATIC GERM-CELL CANCER

Purpose: The long-term sequelae of inferior vena caval (IVC) resection during retroperitoneal lymph node dissection for metastatic nonsemino matous germ cell testis tumor (NSGCT) were assessed. Methods: Between December 1973 and September 1996, 2126 of our patients underwent RPLND for retroperitoneal nodal metastases from NSGCT; 955 had bulky diseas e (stages. B2, B3, or C) after cytoreduction chemotherapy. Of this lat ter group, 65 patients (6.8%) required infrarenal IVC resection during tumor excision for cure. Our protocol does not include IVC reconstruc tion in such cases. Indications for IVC resection included tumor encas ement or encroachment, postchemotherapy desmoplastic compression, or t hrombus with tumor or clot in which cavotomy and thrombectomy cannot b e performed. Results: Twenty-four of the 65 patients (postoperative fo llow-up period range, 11 months to 16 years; median, 89 months) were a live and able to be examined or interviewed by written and/or phone su rvey:to assess the long-term morbidity of their NC resection. Based on the 1994 American Venous forum International Consensus Committee repo rting standards, the clinical classifications of these 24 patients wer e COA (4), C-3S (4), C-4A (2), C-4S (13), and C-6A (1). Long-term disa bility was mild or absent in 75% of these patients. Conclusion: Only 1 (4.2%) of the patients surveyed had chronic venous sequelae that woul d fulfill the accepted criteria for subsequent elective NC reconstruct ion. Despite recent reports of NC reconstruction demonstrating relativ ely good patency rates and low morbidity, the addition of such a compl ex, time-consuming procedure to extensive retroperitoneal lymph node d issection for metastatic NSGCT involving NC resection is generally not necessary.