Retrospective analysis of perioperative mortality after retroperitoneal lymphadenectomy for nonseminomatous testicular tumors

Abstract

The present study is performed to determine whether retroperitoneal lymphadenectomy (rPLa) perioperative mortality (PM) rates reported from center of excellence [Indiana University: 0% for primary and 0.8% for postchemotherapy (PC) rPLa] are applicable to institution at large. Between 1975 and, 327 assessable patients with nonseminomatous testicular tumors (NsTT) were treated with rPLa: primary in 134 (41%) and PC-rPLa in 193 (59%) patients. The observed PM rates were stratified according to age, clinical stage (Cs) and type of rPLa. The median age at rPLa was 28 years (range 16-54) : < 29 years in 194 (56.3%), 30-39 years in 90 (30.3%) and > 40 years in 44 (13.4%) patients. Of 327 rPLa patients, 81 (27.8%) were performed for localized (Cs-I), 179 (54.7%) for regional (Cs-II) and 57 (17.5%) for metastatic (Cs-III) disease. Ten (3.1%) patients died during initial 90 days after rPLa: 1 patient from pulmonary embolism, 2 of chemotherapyrelated toxicity and 7 of progressive disease due to preoperative worse prognostic factors. Of the entire cohort 30, 60 and 90-day PM rate was 0.3%, 1.0% and 1.3%, respectively. PM rate increase with increasing age: < 39 years 0%, 30-39 years 5.0% and > 40 years 9.3% (x2 trend test, P= 0.002). PM rate also increased with Cs: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p<0.001). PM rate at primary and PC-rPLa was increased with Cs: 0% localized, 2.8% for regional and 8.8% for metastatic disease (x2 trend test, p<0.001). PM rate at primary and PC-rPLa was 0.7% and 3.1% 9P<0.001). rPLa was associated with virtually no or low (2.8%) PM rate in patients with localized and regional disease, respectively. In contrast, the PM rate of 8.8% for patients with distant metastases and group > 40 years of age (9.3%) implies that rPLa for these patients ApstraktCilj ove studije je da se odredi koliko perioperativni mortalitet (PM) posle retroperitonealne limfadenektomije (rPLa) iznet od strane iskusnih centara (Indiana University: 0% kod primarne i 0.8% kod posthemioterapijske (PH) rPLa) se može primeniti kod institucija u širem smislu. U periodu od 1975. do 2005., 327 pacijenata sa neseminomskim tumorima testisa (NsTT) je lečeno pomoću rPLa: primarna kod 134 (41%) i PH-rPLa kod 193 (59%) pacijenata. Učestalost PM je analizirana u zavisnosti od godina starosti, kliničkog stadijuma (Ks) i tipa rPLa. srednje životno doba pri rPLa je bilo 28 godina (raspon 16-54): < 29 godina kod 194 (56.3%), 30-39 godina kod 90 (30.9%) i > 40 godina kod 44 (13.4%) pacijenata. Od 327 učinjenih rPLa. 81 (27.8%) su učinjene kod pacijenata u Ks-I, 179 (54.7%) u Ks-II i 57 (17.5%) u Ks-III bolesti. deset (8.1%) pacijenata je umrlo tokom inicijalnih 90 dana posle rPLa: 1 pacijent od embolije pluća, 2 od toksiciteta hemioterapije i 7 od progresije bolesti zbog prisustva loših perioperativnih faktora rizika. Učestalost PM na 30, 60 i 90 dana u celoj grupi pacijenata je iznosila 0.3%, 1.0% i 1.3%, respektivno. PM je imao tendenciju rasta sa porastom godina starosti: < 29 godina 0%,...