Anticoagulation prophylaxis patterns following retroperitoneal lymph node dissection for testis cancer.

Area of Science:

• Urology
• Surgical Oncology
• Cardiovascular Medicine

Background:

• Retroperitoneal lymph node dissection (RPLND) is a standard treatment for testicular cancer.
• Deep vein thrombosis (DVT) and pulmonary embolism (PE) are potential complications following RPLND.
• The benefit of prophylactic anticoagulation (AC) after RPLND is not well-established.

Purpose of the Study:

• To evaluate DVT and PE rates after RPLND.
• To assess trends in postoperative AC use.
• To determine the potential benefit of prophylactic AC in RPLND patients.

Main Methods:

• Retrospective cohort study using national (NSQIP) and institutional databases (2011-2022).
• Analysis of patient characteristics, operative outcomes, and DVT/PE rates.
• Stratification by prior treatment (primary vs. post-chemotherapy RPLND) and clinical stage.
• Calculation of absolute risk reduction (ARR) and number needed to treat (NNT) for AC prophylaxis.

Main Results:

• DVT/PE rates were 1.2%/0.5% (NSQIP) and 2.1%/1.6% (institutional).
• Postoperative AC use increased from 5% to 43% in the institutional cohort (2013-2022).
• ARR for PE with AC was 0.023 (Stage II/III), NNT was 43-44. No significant increase in bleeding events.
• No PEs occurred in Stage I patients, who did not receive AC.

Conclusions:

• Postoperative AC is beneficial and safe after RPLND, particularly for higher-risk patients.
• Increased AC use observed, supporting a risk-stratified protocol.
• Further prospective trials are recommended to confirm AC efficacy in RPLND.