Journal Article

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

Nestler, Tim, Anheuser, Petra, Ruf, Christian Guido, Krampe, Simon, Dieckmann, Klaus Peter, Isbarn, Hendrik, Matthies, Cord, Simon, Jörg

2020

Overview

Background Post-chemotherapy retroperitoneal lymph node dissection (pc-RPLND) is one cornerstone in the clinical management of patients with nonseminomatous testicular germ cell tumours (GCT). A wide range of complication rates in this type of surgery is reported so far. We retrospectively evaluated the frequency of major complications by using the Clavien-Dindo classification and analysed the influence of various clinical factors on complication rates in pc-RPLND. Methods We retrospectively analysed 146 GCT patients undergoing pc-RPLND. Complications of grade III–V according to the Clavien-Dindo classification occurring within 30 days after surgery were registered along with the following clinical factors: age, body mass index (BMI), duration of surgery, number of anatomic fields resected, side of primary tumour, histology of surgical specimen, histology of primary tumour, and total dose of cisplatin applied prior to surgery. For comparison, we also evaluated 35 chemotherapy-naïve patients with primary RPLND and 19 with laparoscopic RPLND. We analysed types and frequencies of the various complications as well as associations with clinical factors using descriptive statistical methods. Results A total of 14.4% grade III–IV complications were observed in pc-RPLND, and 8.6% and 5.3% in primary and in laparoscopic RPLND, respectively. There was no perioperative mortality. Lymphocele was the most frequent adverse event (16% of grade III–IV complications). Operation time > 270 min ( p = 0.001) and vital cancer in the resected specimen ( p = 0.02) were significantly associated with higher complication rates. Left-sided resection fields involved two-fold higher complication rates, barely missing statistical significance ( p = 0.06). Conclusions Pc-RPLND involves a grade III–V complication rate of 14.4%. Prolonged operation time and vital cancer in the residual mass are significantly associated with higher complication rates. The Clavien-Dindo classification system may allow inter-observer variation in rating complication grades, which may represent one reason for the wide range of reported RPLND complication rates. RPLND represents major surgery and surgeons active in this field must be competent to manage adverse events.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Body mass / Body mass index / Body size / Cancer / Care and treatment / Chemotherapy / Cisplatin / Classification / Complications / Development and progression / Dissection / Evaluation / Histology / Humans / Laparoscopy / Literature reviews / Lymph node excision / Lymph Node Excision - adverse effects / Lymph nodes / Lymphatic system / Lymphocele / Male / Medicine / Medicine & Public Health / Methods / Mortality / Neoplasms, Germ Cell and Embryonal - drug therapy / Neoplasms, Germ Cell and Embryonal - surgery / Nonseminoma / Patient outcomes / Patients / Prognosis / Retroperitoneal lymph node dissection / Retroperitoneal Space / Retrospective Studies / Statistical methods / Statistics / Surgery / Surgical complication / Surgical Oncology / Surgical outcomes / Testes / Testicular cancer / Testicular germ cell tumour / Testicular Neoplasms - drug therapy / Testicular Neoplasms - surgery / Tumors