Retroperitoneal recurrences after retroperitoneal lymph node dissection for low-stage nonseminomatous germ cell tumors

Objectives. To evaluate the incidence and sites of retroperitoneal recurren ce after modified retroperitoneal lymph node dissection (RPLND) for low-sta ge nonseminomatous germ cell tumors (NSGCTs). Methods. A retrospective review of 88 patients who underwent RPLND for Stag e I or II NSGCTs between 1971 and 1991 was performed to determine the incid ence and site of any retroperitoneal recurrence. Results. Six retroperitoneal recurrences (four isolated and two in conjunct ion with failures at other sites) were found with a minimum follow-up of 5 years. All 6 patients had left-sided primary tumors, with three recurrences near the left renal hilum and two near the right renal hilum. All recurren ces were at or outside the boundaries of the surgical dissection. Only one retroperitoneal recurrence may have been prevented by performing a bilatera l dissection. Conclusions. Although uncommon, local recurrences can occur after RPLND. Th e right and especially the left renal hilum appear to be at higher risk of failure, possibly because of incomplete dissection in these areas. A more c omplete dissection in these areas may further decrease the local recurrence rate; Overall, the data presented and the studies reviewed suggest that mo dified RPLND reliably removes metastatic tumor with a low failure rate. If failures do occur, they are usually outside of the template and would not: necessarily be prevented with a complete bilateral infrahilar dissection. P ublished by Elsevier Science Inc.