Management of Duodenal Involvement during Retroperitoneal Lymph Node Dissection for Germ Cell Tumors

To describe patient characteristics and outcomes after duodenal repair during PC-RPLND and to identify treatment and management patterns METHODS: The Indiana University Testis Cancer Database was used to identify all patients who underwent simultaneous partial duodenectomy and PC-RPLND from 1983 to 2013. Patient records were reviewed to describe patient and tumor characteristics, type of duodenal restoration, postoperative management and complications.

Of the 2,223 PC-RPLND performed during the study period, 39 patients were identified who underwent simultaneous duodenectomy with one patient requiring 2 duodenal procedures for a total of 40 duodenal procedures. The post chemotherapy median tumor mass size was 8.95 (2.5-17) cm. Fifty percent of cases were standard PC-RPLNDs; the remainders were redo, desperation, or late relapse cases. Preoperative gastrointestinal (GI) symptoms were present in 21% of patients and included bowel obstruction (8%) or GI bleeding (13%). Retroperitoneal pathology consisted of teratoma (48%), cancer (33%), and necrosis (20%). Duodenal involvement was managed with primary duodenorrhaphy (68%), duodenojejenostomy (18%), duodenoduodenostomy (13%), or pancreaticoduodenectomy (3%). Starting in the year 2000, duodenostomy and gastrostomy tubes were no longer utilized. The most common post-operative complication was ileus (45%) with a 3% duodenal fistula rate.

Duodenal tumor involvement during PC-RPLND is most commonly managed with primary duodenorrhaphy after partial duodenectomy with an acceptable duodenal fistula rate. The routine use of duodenostomy or gastrostomy tubes is not recommended.

Urology. 2016 Sep 19 [Epub ahead of print]

Joseph M Jacob, Clint Cary, Song Jiang, Richard S Foster, Michael G House

Indiana University School of Medicine Department of Urology. Electronic address: ., Indiana University School of Medicine Department of Urology., Indiana University School of Medicine., Indiana University School of Medicine Department of Surgery.