title: Retroperitoneal lymph node dissection for metastatic germ cell tumours.
abstract: BACKGROUND
  In the North Trent Cancer network (NTCN) patients requiring retroperitoneal lymphadenectomy for metastatic testicular cancer have been treated by vascular service since 1990. This paper reviews our experience and considers the case for involvement of vascular surgeons in the management of these tumours.
  
  
  METHODS
  Patients referred by the NTCN to the vascular service for retroperitoneal lymphadenectomy between 1990 and 2009 were identified through a germ cell database. Data were supplemented by a review of case notes to record histology, intraoperative and postoperative details.
  
  
  RESULTS
  A total of 64 patients were referred to the vascular service for retroperitoneal lymph node dissection, with a median age of 29 years (16-63 years) and a median follow-up of 4.9 years. Ten patients died: eight from tumour recurrence, one from septicaemia during chemotherapy and one by suicide. Of the 54 who survived, 7 were alive with residual masses and 47 patients were disease-free at the last follow-up. Sixteen patients required vascular procedures: four had aortic repair (fascia), three had aortic replacement (spiral graft), four had inferior vena cava resection, two had iliac artery replacement and two had iliac vein resection.
  
  
  CONCLUSIONS
  Retroperitoneal lymph node dissection often involves mobilisation and/or the resection/replacement of major vessels. We recommend that a vascular surgeon should be a part of testicular germ cell multidisciplinary team.
authors.affiliation: Sheffield Vascular Institute, UK. nanhal@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Haldipur
authors.forename: S
authors.initials: S
authors.lastname: Devaraj
authors.forename: A
authors.initials: A
authors.lastname: Shehata
authors.forename: A K
authors.initials: AK
authors.lastname: Lewis
authors.forename: M O
authors.initials: MO
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Hatton
authors.forename: A
authors.initials: A
authors.lastname: Nassef
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult