Complications of retroperitoneal lymph node dissection

We reviewed the surgical morbidity in 235 patients who underwent retroperitoneal dissection for testis cancer. Of these patients 95 had stage I, 91 had stage II and 49 had stage III disease, and underwent a secondary or primary cytoreductive operation. In the early postoperative period there were 19 major complications in 13 patients (5.5 per cent) and 19 minor complications in 15 patients (6 per cent). There also were 3 late postoperative complications, 2 of which required re-hospitalization. Therefore, the over-all rate of 38 early major and minor complications in 28 patients (11.9 per cent) compares favorably to other reports. These complications generally are treated easily an successfully. However, there is a striking increase in the incidence of operative difficulties and postoperative complications in patients with advanced disease (stage III). Of 49 such patients there were 13 complications. One patient had multiple complications. Also, all patients who had an extensive primary cytoreductive operation suffered either intraoperative or postoperative complications. It is concluded that the complication rate is related directly to the extent of the disease. Factors contributing to this rate are increased operative time, added technical demands, diminished reserve and nutritional status of these patients, and the effects of prior chemotherapy. Therefore, a new population is emerging in cases of testis cancer, namely patients with extensive disease who have had prolonged intensive chemotherapy that alters the pulmonary, hematologic an nutritional status. Specific difficulties are noted and suggestions for management are reviewed.