Reoperative retroperitoneal lymph-node dissection for testicular germ cell tumor

We sought to discuss the indications for reoperative retroperitoneal surgery, preoperative evaluation of patients, distribution of retroperitoneal recurrences and technical considerations for reoperative procedures. In addition, the histologic findings, clinical outcomes and perioperative complications were reviewed.

A PubMED and Medline search was performed to identify reoperative retroperitoneal surgery series for patients with nonseminomatous germ cell tumor.

A reliance on cisplatin-based chemotherapy to treat residual disease after RPLND is inadequate for most patients. If retroperitoneal failure does occur, reoperative RPLND should be considered as the recurrence can harbor viable GCT or teratoma, which both necessitate surgical excision. The left para-aortic and left renal hilar regions are the most common sites of retroperitoneal failure. Reoperative retroperitoneal surgery can be performed with an acceptable morbidity as long as surgeons are equipped to handle significant intraoperative complications. Clinical outcomes after reoperative RPLND are influenced by serum tumor markers, histologic findings and completeness of surgical resection.

Overall survival rates in men requiring redo RPLND appear significantly lower than similar patients who are successfully treated with their initial RPLND. Given the potential complexity of this operation and its impact on a patient's prognosis, reoperative RPLND surgery should be limited to specialized quaternary care centers.