title: Modified and bilateral retroperitoneal lymph node dissection for testicular cancer: peri- and postoperative complications and therapeutic outcome.
abstract: OBJECTIVE
  To characterize surgical invasiveness and morbidity and to verify therapeutic efficacy, we reviewed perioperative and postoperative courses and therapeutic outcomes of patients who underwent retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancers.
  
  
  METHODS
  The study included 31 patients who underwent retroperitoneal lymph node dissection. A modified template was used if retroperitoneal metastasis was limited to the areas below the level of the renal hilus and above the level of the inferior mesenteric artery (IMA). Perioperative and postoperative courses and complications were reviewed as well as therapeutic outcomes.
  
  
  RESULTS
  Overall, 27 perioperative and postoperative complications were observed in 15 patients (48.4%). Superficial surgical site infection and paralytic ileus were seen most frequently. All of them were resolved without special additional treatments; however, patients who underwent retrocrural dissection had a tendency to have severe symptomatic complications such as chylothorax, phrenic nerve palsy and orthostatic hypotension. Antegrade ejaculation was preserved in 94.1% of patients with modified template dissection, whereas no patients with additional dissection below the level of the IMA had the function preserved. One patient (3.2%) developed a postoperative recurrent disease in the retroperitoneum, which was outside the dissection field, as well as in the mediastinum.
  
  
  CONCLUSIONS
  Although RLND had high morbidity, most peri- and postoperative complications were manageable conservatively. Modified template dissection enabled patients to preserve antegrade ejaculation without compromising its therapeutic efficacy, if the disease extension allowed us to use the template.
authors.affiliation: Department of Urology, Sapporo Medical University, School of Medicine, Nishi-16 Chome, Sapporo 060-8543, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kunishima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
authors.forename: Naoki
authors.initials: N
authors.lastname: Itoh
authors.forename: Taiji
authors.initials: T
authors.lastname: Tsukamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D002916:Chylothorax / Q000209:etiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology / Q000556:secondary / Q000601:surgery*; D010243:Paralysis / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D010791:Phrenic Nerve; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome