Retroperitoneal lymph node dissection for testicular cancer is a demanding procedure: detailed real-life data of complications and additional surgical procedures in 295 cases

Abstract

PurposeRetroperitoneal lymph node dissection (RPLND) for germ cell tumours is a challenging procedure that may present relevant complications. The purpose was to analyse postoperative complications and identify risk factors for major complications.MethodsThis is a retrospective unicentric analysis of a large cohort of 295 RPLNDs from 1992 to 2020. Early complications (30 days) and late complications (31–180 days) were classified according to the Clavien‒Dindo classification. The influence of surgical, patient-specific, and tumour-specific parameters on grade III–V complications was analysed in univariate and multivariate logistic regression models.ResultsA total of 232 were postchemotherapy RPLNDs, and 63 were primary RPLNDs. Early postoperative complications were found to be grades I–II in 58.6% (173/295), grades III–IV in 9.8% (29/295), and grade V in 0.3% (1/295). In 20% (58/295), additional surgical procedures were needed. Grade III–V complications were associated with ≥ 4 cycles of preoperative chemotherapy (OR 3.7 (1.5–8.9); p = 0.004), RPLND specimen (nonseminoma or immature teratoma) (OR 3.1 (1.4–6.6); p = 0.005), transfusions (OR 2.4 (1.1–5.4); p = 0.03), salvage RPLND (OR 4.1 (1.8–9.3); p < 0.001), and preoperatively elevated AFP (OR 5 (2.2–11.7); p < 0.001). In multivariate analysis, the only independent predictor for grade III–V complications was preoperative AFP elevation (OR 3.3 (1.2–9.2); p = 0.02). Limitations include the retrospective study design.ConclusionsOur results demonstrate that RPLND is a demanding surgical procedure. Patients with a complex tumour history have a higher risk of complications. We recommend treatment of these complex cases in high-volume centres.