Assessing complications from retroperitoneal lymph node dissection for testicular cancer in North America

Retroperitoneal lymph node dissection (RPLND) is a procedure of significant therapeutic and diagnostic value in the management of testicular cancer. This study aimed to conduct a contemporary review of surgical outcomes following RPLND procedures performed in North America over the last decade.

We queried the National Surgical Quality Improvement Program (NSQIP) database from 2012-2022 (n=9 857 040) to identify patients who underwent RPLND and were diagnosed with testicular cancer. The primary outcome was 30-day morbidity. Secondary outcomes included time-to-complication analysis, rate of additional organ resection, hospital length of stay (LOS), and readmission rates. Binomial logistic regression and a generalized linear model were used to identify risk factors associated with 30-day morbidity and LOS.

A total of 513 RPLND procedures met the inclusion criteria. The median age was 30 years (interquartile range [IQR] 24-36.50) with a body mass index of 27.9 kg/m² (IQR 24.5-32.0). There were no deaths within 30 days. The overall 30-day morbidity rate was 17% (n=86). Bleeding/transfusion postoperatively (12%), return to the operating room (3%), and superficial surgical-site infection (2%) were the three most common complications. Factors associated with increased 30-day morbidity included: history of smoking (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.35-4.68) and concurrent vascular repair/reconstruction (OR 4.1, 95% CI 1.12-15.46). The median LOS was four days (IQR 3-6) and the 30-day readmission rate was 7.0%.

This study underscores that approximately one in six patients experience complications following RPLND in North America. Identifying the timing of and risk factors for these complications can improve physician-patient communication and overall care.