Early and late complications of retroperitoneal lymphadenectomy in testis cancer.

The complications arising from 100 consecutive retroperitoneal lymphadenectomies done for nonseminomatous germ-cell tumours of the testis were reviewed. Thirty procedures were performed with sparing of sympathetic nerve fibres. There were no operative deaths. Complications were not stage-related, and the sympathetic nerve-sparing procedure did not alter their frequency. Long-term follow-up in the same cancer centre allowed documentation of all early and delayed complications as a measure of burden of surgical therapy. Median follow-up for survivors was 44 months. Complications that resulted in delayed hospital discharge or further operative intervention at any time were defined as major; all others, resulting in minimal morbidity to the patient, were documented as minor. Injury to renal vessels occurred in four patients intraoperatively. Delayed complications included small-bowel obstruction requiring laparotomy (six patients), incisional hernia requiring repair (two patients) and urethral stricture requiring urethroplasty (one patient). There were 49 complications (14 major, 35 minor) in 35 patients. The authors conclude that the majority of complications after retroperitoneal lymphadenectomy are minor and cause little morbidity. This information is useful when comparing surgery to alternative therapy with similar outcomes. The overall burden of treatment becomes all-important in the selection of optimal therapy.