Postchemotherapy laparoscopic retroperitoneal lymph node dissection: evaluation of complications.
OBJECTIVE
Initial publications on postchemotherapy laparoscopic retroperitoneal lymph node dissection (LRPLND) have described significant intraoperative and postoperative morbidities. This report reviewed the complication rate with additional experience.


METHODS
A retrospective review of the medical records of 16 consecutive patients who underwent postchemotherapy LRPLND by a single surgeon from September 1996 to September 2005 was performed. The evaluation included tumor type, clinical stage, pathologic stage, and intraoperative and postoperative complications.


RESULTS
Postchemotherapy LRPLND was successfully performed in 14 (87.5%) of 16 patients. Seven patients (43.8%) developed complications and 2 (12.5%) required open conversion. The most complications occurred during the postoperative period and were classified as minor. Of the total patient population, 25% had minor postoperative complications. The median hospital stay was 2 days. No patient who underwent the procedure died. All intraoperative complications were vascular injuries and occurred during the first half of the series (1996 to 2000). In the second half of the series (2000 to 2005), no complications during the operative period and no vascular or major complications occurred. No retroperitoneal recurrence was noted during a mean follow-up of 32.7 months (range 5 to 108). One patient developed distant recurrence and underwent successful salvage chemotherapy.


CONCLUSIONS
Postchemotherapy LRPLND remains a challenging, but feasible, operation. With greater experience, the incidence of complications and morbidity can be reduced.
Permpongkosol
Sompol
S
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Lima
Guilherme C
GC
Warlick
Christopher A
CA
Allaf
Mohamad E
ME
Varkarakis
Ioannis M
IM
Bagga
Herman S
HS
Kohanim
Sahar
S
Kavoussi
Louis R
LR
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001707:Biopsy, Needle; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D011336:Probability; D012074:Remission Induction; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome