Reoperative retroperitoneal surgery for XXXX : clinical presentation, patterns of recurrence, and outcome.

@entity1 @entity10711 @entity5 @entity44
OBJECTIVES: To describe the clinical characteristics and outcome of @entity1 with metastatic @entity10711 requiring reoperative retroperitoneal surgery at the Memorial Sloan-Kettering Cancer Center, because such @entity1 are poorly characterized. METHODS: The Memorial Sloan-Kettering Cancer Center germ cell @entity5 surgical database was reviewed from January 1989 through April 2001, and the clinical characteristics of @entity1 undergoing reoperative retroperitoneal surgery for @entity10711 were identified. The initial presentation, histologic findings, morbidity, and survival were analyzed. Disease-specific survival was calculated using the Kaplan-Meier method. RESULTS: A total of 56 @entity1 underwent 61 repeat operations: 22 after primary retroperitoneal lymph node dissection (RPLND) and 34 after postchemotherapy RPLND. Left testicular primary @entity5 were more common than right (33 versus 23), and the most common sites of disease prompting reoperation were the para-aortic and left hilar regions. @entity44 was the most common histologic finding at the time of reoperation. Of 56 @entity1 , 37 (66%) required chemotherapy between the initial operation and reoperation. The overall perioperative complication rate was 27%, and median length of hospital stay was 8 days. Sixty-nine percent of @entity1 required adjunctive procedures at the time of reoperation, the most common of which was thoracotomy. The 5-year disease-specific survival rate was 67% for the entire group (86% following reoperation after primary RPLND and 56% following reoperation after postchemotherapy RPLND). CONCLUSIONS: Reoperative retroperitoneal surgery for @entity10711 can be performed with acceptable morbidity in select referral centers. @entity44 is highly prevalent in the retroperitoneum at the time of reoperation. A significant subset of these high-risk @entity1 can be salvaged with complete resection.
