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Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Metastatic Testicular Cancer at a National Referral
Konstantinos Evmorfopoulos1, Panagiotis J Vlachostergios2,3, Georgios Chasiotis1
1Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece.
Objective:
To assess the safety of open PC-RPLND at a high-volume national referral centre over the course of several years.
Materials And Methods:
A retrospective chart review of patients with testicular germ cell tumours (TGCTs) who underwent PC-RPLND at our institution between 2008 and 2023 was conducted. Patient demographics, clinical characteristics, intraoperative and postoperative parameters and adjunctive procedures were recorded. ClassIntra and Clavien Dindo classifications were used to assess intraoperative and postoperative complications, respectively.
Results:
In total, 165 patients were studied. The median (Q1-Q3) age of patients was 30.5 years (24.75-38.25), and the median maximum diameter of retroperitoneal masses was 50 mm (26.75-81.25). The most common adjunctive procedure was synchronous nephrectomy (n = 18, 11%) followed by vascular procedures (n = 7, 4.3%), ureteric reconstruction (n = 7, 4.3%), and partial hepatectomy (n = 3, 1.9%). Intraoperatively, 20, 8 and 1 patient had a grade I, II or V complication, respectively, according to the ClassIntra classification. The median estimated blood loss was 300 mL (120-740), the median duration of the procedure was 4.9 h (4-6 h) and the median length of stay was 8 days (7-10 days). Histopathological examination of the resected specimen showed teratoma in 51.9% of patients, followed by fibrosis/necrosis in 39.5%. A total of 40 patients (24.7%) experienced at least one complication.
Conclusions:
PC-RPLND is a complex operation, often accompanied by adjunctive surgical procedures and therefore must be conducted in high-volume referral centres to ensure safety and minimise complications.
