Surgical Complications in Postchemotherapy Retroperitoneal Lymph Node Dissection for Nonseminoma Germ Cell Tumour: A Population-based Study from the Swedish Norwegian Testicular Cancer Group

Abstract

Background Reports on perioperative complications after Post-Chemotherapy Retroperitoneal lymph node dissection (PC-RPLND) for Non-Seminoma Germ Cell Tumour (NSGCT) are from experienced single centres, with a lack of population-based studies. Objective To assess the complications of bilateral and unilateral PC-RPLND. Design, Setting, Participants Prospective, population-based observational multicentre study that included all patients with NSGCT that underwent PC-RPLND in Norway and Sweden 2007 to 2014. In total 318 patients, 87 underwent bilateral PC-RPLND and 231 unilateral PC-RPLND. Median follow-up 6 years.Outcome measurements and statistical analysis Bilateral and unilateral PC-RPLND were compared for the outcome intra-and postoperative complications (graded by Clavien-Dindo) and retrograde ejaculation (with or without nerve-sparing surgery). Complications were reported as absolute counts and percentages. The x 2 -test was used for comparisons Results and LimitationsThe incidence of intraoperative complications was higher for bilateral PC-RPLND compared to unilateral PC-RPLND (14% vs. 4.3%, p=0.003), with ureteral injury as the most frequent reported complication (2% of the patients). Postoperative complications were more common after bilateral than unilateral PC-RPLND (45% vs 25%, p=0.001) with Clavien ≥3b reported in 8.3% and 2.2% respectively (p=0.009). Lymphatic leakage was the most common complication occurring in 11% of the patients. Retrograde ejaculation occurred more frequently after bilateral than unilateral surgery (59% vs 32%, (p<0.001). Limitation of the study include reporting of retrograde ejaculation, which was based on chart review. Conclusions Intraoperative complications and postoperative complications includingretrograde ejaculation are more frequent after bilateral PC-RPLND compared to unilateral PC-RPLND.

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

“…small bowel obstruction and postoperative ileus. In accordance with our finding, a Scandinavian study reported a higher rate of adjunctive measures in left-sided resections [38].…”

“…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].…”

“…Low-dose radiotherapy was used to manage the complication in those cases. In contemporary series of p-RPLND and pc-RPLND, reported rates of lymphocele formation range from 0 to 14.6%, with the majority of studies reporting low rates of 1.5 to 5% [15,27,40,47,57], but some also report higher rates of 10.9% [30], 11% [38], and 14.6% [29]. Probably, the wide range of lymphocele occurrences reported can be attributed to differences in coding systematics.…”

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

“…The only major complication in our series was a lymphocele requiring drainage. This is in contrast with several population-based studies on open RPLND, which have reported average complication rates of ~ 25% [30,31].…”