Aortic replacement during post-chemotherapy retroperitoneal lymph node dissection

Purpose: We reviewed the records of 15 patients with metastatic germ cell c ancer who underwent aortic resection and replacement during post-chemothera py retroperitoneal lymph node dissection to determine the morbidity and the therapeutic benefit. Materials and Methods: Between 1970 and 1998, 1,250 patients underwent post -chemotherapy retroperitoneal lymph node dissection. Our retrospective revi ew revealed that 15 patients underwent aortic replacement at that operation . Results: In addition to aortic replacement 11 patients underwent 15 additio nal procedures, including nephrectomy in 7, vena caval resection in 3, pulm onary resection in 1, small bowel resection in 2, 1 hepatic resection in 1 and L4 vertebrectomy in 1, No patient had necrosis as the only pathological condition. Three patients (20%) had teratoma and 12 (80%) had viable tumor in the retroperitoneal specimen. All 4 patients who underwent post-chemoth erapy retroperitoneal lymph node dissection and aortic replacement after in duction chemotherapy alone have no evidence of disease, Only 1 of the 11 pa tients who received salvage chemotherapy with or without previous post-chem otherapy; retroperitoneal lymph node dissection have no evidence of disease , Overall 33% of the patients have no evidence of disease. There were no gr aft related complications. Conclusions: Aortic resection at post-chemotherapy retroperitoneal lymph no de dissection is justified based on therapeutic benefit and morbidity.