Redo Retroperitoneal Lymphadenectomy for Germ Cell Tumor of the Testis: Incan Experience (Instituto Nacional De Cancerologia, Mexico City) and Review of Literature

Introduction: Redo retroperitoneal lymph node dissection (Redo surgery) for the treatment of germ cell tumors (GCTs) is an uncommonly performed procedure. We describe clinical characteristics and outcome of patients disease requiring redo surgery for recurrence or residual retroperitoneal disease. Materials and methods: INCan (Instituto Nacional de Cancerologia) germ cell tumor surgical database was reviewed from January 2007 to December 2012 and clinical features of patients subjecting to re-operative retroperitoneal surgery (Redo surgery) for GCTs were individualized. Preoperative evaluation, histopathology, morbidity, and technical aspects of this procedure, which is a critical part of the management of GCT, are described. Disease-specific survival was estimated using the Kaplan-Meier method. Results: A total of 20 patients were identified who underwent 27 Redo surgery, after post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND). The most common sites of disease in the Redo surgery were para-aortic region. The most frequent histologic finding at time of Redo surgery was teratoma. The median interval to Redo surgery was 12 moths (P 25 8.5-P 75 14.75). The overall Intraoperative complication rate was 18% and median length of hospital stay was 3days. The 5-year disease-specific survival rate was >55%. Disease-specific mortality for patients underwent to Redo surgery was 40% (n=8). Conclusion: Redo surgery is integral component of management of GCTs in cases of retro peritoneum recurrences of failures; it is the last opportunity for cure. Clinical outcomes after repeating retroperitoneal surgery depend on re operative histology.