Aortic replacement during post-chemotherapy retroperitoneal lymph node dissection.
OBJECTIVE
We reviewed the records of 15 patients with metastatic germ cell cancer who underwent aortic resection and replacement during post-chemotherapy retroperitoneal lymph node dissection to determine the morbidity and the therapeutic benefit.


METHODS
Between 1970 and 1998, 1,250 patients underwent post-chemotherapy retroperitoneal lymph node dissection. Our retrospective review revealed that 15 patients underwent aortic replacement at that operation.


RESULTS
In addition to aortic replacement 11 patients underwent 15 additional procedures, including nephrectomy in 7, vena caval resection in 3, pulmonary 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-chemotherapy retroperitoneal lymph node dissection and aortic replacement after induction chemotherapy alone have no evidence of disease. Only 1 of the 11 patients who received salvage chemotherapy with or without previous post-chemotherapy retroperitoneal lymph node dissection have no evidence of disease. Overall 33% of the patients have no evidence of disease. There were no graft related complications.


CONCLUSIONS
Aortic resection at post-chemotherapy retroperitoneal lymph node dissection is justified based on therapeutic benefit and morbidity.
Beck
S D
SD
Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Foster
R S
RS
Bihrle
R
R
Koch
M O
MO
Wahle
G R
GR
Donohue
J P
JP
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002945:Cisplatin / Q000008:administration & dosage; D018237:Germinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016879:Salvage Therapy; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology*
D002945:Cisplatin