Reduced morbidity in resection of residual tumors after chemotherapy for seminoma

Abstract

Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) is associated with complications and decreased adjunctive surgery. Little data are available concerning PC-RPLND in patients with advanced seminomas and residual retroperitoneal tumor lesions. We examined intra- and postoperative complications as well as the frequency of adjunctive surgeries in patients with seminoma and compared the data to a cohort of patients with non-seminomatous germ cell tumors (NSGCT) who underwent PC-RPLND. In our retrospective analysis, 580 patients (43 patients with advanced seminomas and 537 patients with NSGCT) underwent PC-RPLND between 1989 and 2010. The surgical approach was preferred via midline incision or a thoracoabdominal approach depending on the location of the residual tumor. Of the 43 patients with seminoma, a total number of 13 adjunctive surgeries were performed in 7 patients. There were only three intraoperative complications, two postoperative complications (prolonged intestinal paralyses). There were no significant differences in adjunctive surgeries and postoperative complications (p=0.49 and p=0.133) between the two groups. There were significantly fewer intraoperative complications in favor of seminomas (p=0.001). PCRLND in seminomas and NSGCT is a demanding surgical intervention. In contrast to other series we did not find significant differences in the two patient groups concerning adjunctive surgeries and postoperative complications. The indication for PCLND in patients with seminoma is limited, but if necessary it can be performed safely in experienced centers.