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

To evaluate the perioperative morbidity of PC-RPLND in two intermediate volume centers and to identify predictors of high morbidity.

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.

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).

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.

World journal of urology. 2020 May 05 [Epub ahead of print]

Joost M Blok, Richard P Meijer, Henk G van der Poel, Axel Bex, Jeanette van Vooren, Japke J van Urk, Simon Horenblas, J L H Ruud Bosch

Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands. ., Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands. ., Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands.

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