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The present study is performed to determine whether retroperitoneal lymphadenectomy (RPLA) perioperative mortality (PM) rates reported from center of excellence [Indiana University: 0% for primary and 0.8% for postchemotherapy (PC) RPLA] are applicable to institution at large. Between 1975 and 2005, 327 assessable patients with nonseminomatous testicular tumors (NSTT) were treated with RPLA: primary in 134 (41%) and PC-RPLA in 193 (59%) patients. The observed PM rates were stratified according to age, clinical stage (CS) and type of RPLA. The median age at RPLA was 28 years (range 16-54) : 40 years in 44 (13.4%) patients. Of 327 RPLA patients, 81 (27.8%) were performed for localized (CS-I), 179 (54.7%) for regional (CS-II) and 57 (17.5%) for metastatic (CS-III) disease. Ten (3.1%) patients died during initial 90 days after RPLA: 1 patient from pulmonary embolism, 2 of chemotherapy related toxicity and 7 of progressive disease due to preoperative worse prognostic factors. Of the entire cohort 30, 60 and 90-day PM rate was 0.3%, 1.0% and 1.3%, respectively. PM rate increase with increasing age: 40 years 9.3% (x2 trend test, P=0.002). PM rate also increased with CS: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p 40 years of age (9.3%) implies that RPLA for these patients should be performed at centers of excellence, with intent of reducing PM rate.

Retrospective analysis of perioperative mortality after retroperitoneal lymphadenectomy for nonseminomatous testicular tumors