The surgical complications encountered in 478 patients who underwent primary retroperitoneal lymphnode dissection for clinical stage A and B nonseminomatous testicular cancer during the period ranging from 1982 to 1992 were reviewed. There were 54 complications in 51 patients (10.6%), and there was no surgery-related mortality. There were 16 minor complications and 38 major complications. The most frequent complication encountered was superficial wound infection, and many of the major complications were related to small-bowel obstruction and atelectasis. The incidence of complications was significantly lower in patients operated on during the last 6 years of the study (1987)(1988)(1989)(1990)(1991)(1992). The complication rate was lower in patients who underwent modified unilateral procedures than in those who had bilateral dissections. The ejaculation rate of patients undergoing nervesparing procedures was 98%. This study reinforces the conclusion that primary retroperitoneal lymph-node dissection is an operation yielding minimal morbidity and no long-standing effect.
Retroperitoneal lymph-node dissection (RPLND) serves the dual purpose of staging and treatment of low-stage testicular cancer. Patients with clinical stage a disease treated initially by RPLND with or without additional adjuvant chemotherapy for node-positive disease attain a rate of survival of 99% [l, 2]. Experience gained with surveillance in the same group of patients demonstrates the survival of about 96% [3,4]. As both treatment regimens have approximately the same capability for cure, the current debate involves the decision as to which is less morbid for the patient.
Morbidity is addressed according to the short-and long-term effect on the patients. In the surgical treatment group (primary RPLND), morbidity would results mainly from the operative procedure itself. On the surveillance protocol, where patients are on close follow-up without being treated postorchiectomy, the morbidity would be related to those patients who relapse and are treated with full-dose combination chemotherapy and possible postchemotherapy RPLND.