Peri-operative care in patients treated for testicular cancer

The success of combination chemotherapy in treating advanced metastatic ger m cell tumors has led to new challenges for the genitourinary oncologic sur geon in the peri-operative care of patients. Surgery remains an integral pa rt of the management of patients with advanced germ cell tumors. Retroperit oneal node dissections following chemotherapy or radiation, or both, are te chnically more demanding and subject to higher rates of peri-operative comp lications. Overall post-therapy surgical complication rates range from 33% to 75%, with the highest rates among patients who receive both radiation an d chemotherapy. Although most patients with testicular cancer are young and healthy, residual pulmonary, renal, vascular, and neurologic toxicities fr om chemotherapy can increase the risk of peri-operative complications. In a ddition, the volume and location of tumor can increase the technical demand s, especially when there is a tremendous soft tissue reaction to the chemot herapy. Identification of pre-operative risk factors for peri-operative com plications is imperative and the first step in pre-operative planning. Pulm onary toxicity and vascular (cardiac or peripheral) events are the two most immediately life-threatening complications that can occur in the peri-oper ative period. Due to the high incidence of subclinical pulmonary toxicity, one must consider all patients who have received bleomycin pre-operatively at risk to develop postoperative pulmonary problems. Pre-operative evaluati on and judicious fluid management have been shown to reduce the risk of lif e-threatening respiratory complications in the postoperative period. Semin. Surg. Oncol. 17:282-288, 1999, (C) 1999 Wiley-Liss, Inc.