ABSTRACT
The role of retroperitoneal lymph node dissection (RPLND) in the management of germ cell cancer is both staging and therapeutic. In low volume disease primary RPLND defines the pathologic stage and is curative in the setting of metastatic disease allowing for the avoidance of chemotherapy. Severe pulmonary complications after RPLND are fortunately rare, and likely secondary to bleomycin toxicity. Intraoperative bowel injury is uncommon during RPLND and when recognized has little morbidity. Subserosal injury to the duodenum may occur during mobilization of the second and third portion of the duodenum off the vena cava and area often densely adherent. Ureteral injury is uncommon and typically occurs in the postchemotherapy setting. At primary RPLND, one ureteral injury occurred in 478 cases at Indiana University. Neurologic sequelae after RPLND are uncommon and if present are typically transitory. In 603 postchemotherapy surgeries in the Indiana series, seven patients experienced a peripheral neurologic injury.
