title: Repeat retroperitoneal lymph node dissection for metastatic testis cancer.
abstract: OBJECTIVE
  We report pathological results, perioperative complications and patient outcome in 21 men after repeat retroperitoneal lymph node dissection for metastatic testis cancer.
  
  
  METHODS
  We reviewed an institutional tumor registry at our cancer center and identified 417 patients who underwent retroperitoneal lymph node dissection for testis cancer during a 21-year period. Of these 417 patients 21 underwent repeat retroperitoneal lymph node dissection. We reviewed preoperative patient characteristics, operative data and pathological findings from repeat lymphadenectomy, and determined patient disease status, morbidity and mortality after surgery.
  
  
  RESULTS
  We identified viable germ cell tumor in 5 patients (24%), teratoma in 14 (67%) and fibrosis or necrosis only in 5 (24%). Intraoperatively subadventitial dissection of the aorta occurred in 2 cases, which was severe enough in 1 to require an aortic graft. The most common postoperative complications were prolonged ileus or partial bowel obstruction and chylous ascites in 6 and 3 patients, respectively. Six patients died, including 5 of disease progression and 1 of postoperative pulmonary embolus. At a mean followup of 4.7 years (range 0.1 to 14) 15 patients (71%) were alive and 14 (67%) were disease-free.
  
  
  CONCLUSIONS
  Repeat retroperitoneal lymph node dissection is safe and effective in the majority of patients with recurrent or residual retroperitoneal masses after initial multimodality treatments for metastatic testis cancer. Overall perioperative morbidity and mortality are low and yet the potential for significant vascular complications warrants careful preoperative planning and intraoperative judgment.
authors.affiliation: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Richard
authors.initials: R
authors.lastname: Kim
authors.forename: Louis L
authors.initials: LL
authors.lastname: Pisters
mesh_terms: D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*