Intraoperative and early postoperative outcomes in post-chemotherapy retroperitoneal lymphadenectomy using validated grading classifications.

Abstract

535 Background: Post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) is an integral treatment modality in the management of advanced germ cell tumors. We sought to define the complication profile of PC-RPLND using validated grading systems for intraoperative adverse events (iAE) and early postoperative complications. Methods: After IRB approval, we analyzed perioperative outcomes of 453 patients (pts) who underwent PC-RPLND between 2000 and June 2018. iAE and early postoperative complications (within 90 days) were graded using Kaafarani and Clavien-Dindo classification, respectively. Logistic regression models were conducted to assess patient and tumor factors associated with iAEs and postoperative complications. Results: Of the 453 pts, 287 (63%) were clinical stage III and had a median post-chemotherapy retroperitoneal mass size of 4.1 cm (IQR 2.4-7.4 cm). There were 132 iAE, which occurred in 115 (25%) pts. Early postoperative complications occurred in 255 (56%) pts. Major iAE (grade ≥ 3) was observed in 15 (3%) pts and major postoperative complications (grade ≥ 3) were noted in 83 (18%) pts. The most common iAE was vascular injury (112 of 132 events, 85%), which occurred in 92 (20%) pts. The most common postoperative complication was ileus, occurring in 121 (27%) pts. Residual retroperitoneal mass size (OR = 1.14; 95% CI: 1.09–1.20, p<0.001), non-pulmonary metastases (OR = 3.18; 95% CI: 1.68–6.00, p<0.001), previous laparotomy (OR = 1.92; 95% CI: 1.01–3.66, p=0.047), previous RPLND (OR = 1.14; 95% CI: 1.01–5.59, p=0.046), and adjuvant surgical procedures (OR = 13.54; 95% CI: 7.01–26.14, p<0.001) increased the risk of iAE and postoperative complications. Postoperative complications were more likely for patients that experienced an iAE (OR = 2.50; 95% CI: 1.58–3.97, p<0.001). Conclusions: This is the first analysis of PC-RPLND defining morbidity using validated classifications of severity for iAE and postoperative complications. Larger retroperitoneal mass, non-pulmonary metastases, previous surgery and adjuvant surgical procedures increased the risk of perioperative complications. iAE increased the risk of postoperative complications.