Objective: Retroperitoneal lymph node dissection (RLND) is frequently performed in non-seminomatous testicular tumor (TT) patients, especially in cases who have radiological residual mass despite normal tumor markers after chemotherapy (CT). On the other hand, additional surgical procedures may be required in post-CT patients during RLND due to high probability of severely invasion of residual mass to surrounding organs and major vascular structures. In this study, we aimed to evaluate the additional surgical procedures and complications during RLND. Materials and Methods: Between January 2000-July 2015, 63 metastatic non-seminomatous TT patients undergoing RLND due to residual mass after CT at our clinic were evaluated for additional surgical procedures during RLND. Age at surgery, localization of TT, clinic stage before CT, number of CT cycles, retroperitoneal mass size, duration of hospitalization, history of additional surgical procedures during surgery and RLND’s pathology of patients were evaluated. Clinic stage before CT was assessed according to 2009 tumor, node, metastasis staging system. For all patients, RLND was performed as right or left template according to localization of tumor. Results: The mean age of patients was 32.6±8.6 years. Additional surgical procedures were performed in 10 (15.9%) patients. In five patients, ipsilateral nephrectomy, in two patients vena cava excision and repair, in one patient aorta excision and replacement, in one patient ureteral segment excision and anastomosis and in one patient transverse colon resection were performed. On multivariate analysis, >5 cm mass size was determined to increase likelihood of significant additional surgical procedure (p=0.001, OR: 2.1, 95% CI: 1.088-4.202). Conclusion: For complete resection, the most common additional surgical procedure during surgery is nephrectomy following CT in RLND patients. However, major vascular procedures such as aort or vena cava excision and replacement may be required are need in more complex cases.
Keywords: Additional surgery, chemoteraphy, retroperitoneal lymph node dissection, testicular tumor