Login to Access Video or Poster Abstract: MP80-20
Sources of Funding: None

Introduction

Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is standard of care for patients with advanced germ cell tumors and residual disease. Due to the invasiveness and complexity of the disease additional surgical procedures may be necessary. This analysis aims to quantify the additional procedures in order to define the necessity for other surgical specialties on an ad hoc basis._x000D_

Methods

We performed a retrospective analysis of 431 PC-RPLNDs in 382 patients for intra- and postoperative complications as well as additional surgical procedures. Complications were classified by Clavien-Dindo grading. _x000D_

Results

431 RPLNDs with 383 PC-RPLNDs were performed between 2008 und 2016 in a single center. Mean patient age was 35 years with a mean tumor size of 6 cm. PC-RPLND was performed unilaterally in 176 patients (40.8%) and bilaterally in 253 patients (58.7%). Mean OR time was 217 minutes (range 60-510 min) with a mean intra-operative blood loss of 1026 cc (range 0-15000). 128 patients (29.7%) received blood transfusions. A significant vascular intervention during the operation occurred in 78 patients (18.1%) – vena cava procedures including resection and cavotomie were necessary in 24 patients (7.2%) and aortic replacement in 7 patients (1.8%). Nephrectomy was performed in 41 cases (9.7%), 32 patients received partial liver resection (7.4%) and 14 patients needed vertebral resection (3.2%). During the postoperative course 24 patients (4.6%) showed a lymphocele. Complications by Clavien Grading: (including post OP complications) Grade I: 84 (19.4%) (inclusive post OP hematoma and lymphocele), Grade II: 128 (29.6%) (incl. blood transfusion); Grade III: 9 (2.1%); Grade III b: 9 (2.1%); Grade IV a: 4 (0.9%); Grade V: 1 (0.2%)._x000D_

Conclusions

PC-RPLND in testis cancer patients is a demanding operation which frequently requires a multivisceral surgical approach in about 30% of cases. Adjunctive surgical procedures which require other surgical specialties such as vascular interventions including cava resection, aortic grafting or extensive liver and vertrebral resections may be ad hoc necessary. Consequently tertial referral centers are defined to provide ad hoc surgical specialty service and this type of surgery should not be perfomed outside of these centers due to the high frequency of a multivisceral approach._x000D_

Funding

None