Are we missing an important point? Risk factors for intraoperative complications and additional procedures when...

Area of Science:

• Oncology
• Surgical Oncology
• Urology

Background:

• Advanced germ-cell tumors often require post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND).
• PC-RPLND can involve complex procedures with potential for additional intraoperative interventions.
• Identifying risk factors for these interventions is crucial for surgical planning and patient outcomes.

Purpose of the Study:

• To identify risk factors for additional intraoperative procedures during PC-RPLND in patients with advanced germ-cell tumors.
• To determine predictors of surgical complications and extended operative time.

Main Methods:

• Retrospective analysis of 206 patients undergoing PC-RPLND for advanced germ-cell tumors (1990-2022).
• Definition of additional procedures including vascular, renal, intestinal, ureteral repairs, and en-bloc resections.
• Univariate and multivariate logistic regression to identify independent predictors.

Main Results:

• 27.2% of patients (56/206) required 67 additional procedures.
• Vascular procedures were most common (19.4%), followed by nephrectomy (4.9%) and intestinal/ureteral repairs (4.4%, 3.9%).
• Initial tumor size and presence of viable tumor post-chemotherapy were independent risk factors (P < .05).

Conclusions:

• Initial tumor size, not preoperative size, predicts the need for additional procedures during PC-RPLND.
• The likelihood of viable tumor is a significant predictor for requiring further surgical interventions.
• Surgical planning should consider initial tumor burden and viable disease to optimize perioperative outcomes in advanced germ-cell tumor patients.