Additional surgical procedures and perioperative morbidity in post-chemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer in two intermediate volume hospitals

Abstract

Purpose To evaluate the perioperative morbidity of PC-RPLND in two intermediate volume centers and to identify predictors of high morbidity. Methods Retrospective analysis of 124 patients treated with open PC-RPLND at two tertiary referral centers between 2001 and 2018. Perioperative morbidity was determined by analyzing additional surgical procedures, intra-operative blood loss, and postoperative complications. Results An additional procedure was necessary for 33 patients (26.6%). The risk was higher in patients with IGCCCG intermediate/poor prognosis (OR 3.56; 95% CI 1.33–9.52) and residual tumor size > 5 cm (OR 3.53; 95% CI 1.39–8.93). Blood loss was higher in patients with IGCCCG intermediate/poor prognosis (β = 0.177; p = 0.029), large residual tumor (β = 0.570; p < 0.001), an additional intervention (β = 0.342; p < 0.001) and teratoma on retroperitoneal histology (β = − 0.19; p = 0.014). Thirty-one patients had a postoperative complication Clavien-Dindo Grade ≥ 2 (25.0%). Complication risk was highest in patients undergoing an additional intervention (OR 3.46; 95% CI 1.03–11.60; p = 0.044). Conclusions The rate of additional interventions in our series is comparable to what has been reported in high-volume centers. IGCCCG intermediate/poor prognosis patients with high-volume disease and patients undergoing an additional surgical procedure can be classified as high-risk patients.

Major complications of post-chemotherapy retroperitoneal lymph node dissection in a contemporary cohort of patients with testicular cancer and a review of the literature

“…No perioperative mortality was observed in our series, which is consistent with other recent reports [8,13,27,30,31,33,34,36]. Low mortality rates of 0.20 to 1.6% [12,29,32,35,38,39] were reported in some other studies ( Table 5). In a Dutch series, one death due to anaesthesiological problems was reported [40].…”

“…An overview of contemporary studies providing data on grade III-V complications utilizable for comparison is given in Table 5. Five studies reported higher rates than the present series [27][28][29][30][31], 10 lower [8,12,15,[32][33][34][35][36][37][38][39].…”

Clinical outcome of robot-assisted residual mass resection in metastatic nonseminomatous germ cell tumor

“…On the condition that oncological safety is warranted, this may provide significant benefit to patients. After all, the morbidity of open PC-RPLND is high, while histopathology of the retroperitoneal specimen shows fibrosis or necrosis in a large proportion of patients [3,4,12,13].…”

Adjunctive Surgery Is Often Without Oncological Benefit at Time of Postchemotherapy Retroperitoneal Lymph Node Dissection

“…This incidence is comparable to that in the literature, with rates of 34% to 71%. 4,6,7,16,18 The resection/reconstruction of venous vessels is much more common than that of arteries. The second most resected organ in our analysis was the kidney in 32% of patients with adjacent resection, with 33% of them harboring only N. In most other studies, nephrectomy was also the second most resected organ, with 15% to 42% of patients undergoing adjacent resections.…”

“…The second most resected organ in our analysis was the kidney in 32% of patients with adjacent resection, with 33% of them harboring only N. In most other studies, nephrectomy was also the second most resected organ, with 15% to 42% of patients undergoing adjacent resections. 4,6,7,16,18,19 A partial hepatectomy was performed in 21% of studied patients, with N being present in 54% of patients. Other studies reported a frequency of 6% to 19% with a partial hepatectomy within patients undergoing adjunctive surgery.…”