Complications of postchemotherapy retroperitoneal lymph node dissection for advanced testicular cancer
Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in metastatic non-seminomatous testicular cancer (NSGCT) is an important part of the SWENOTECA management program (Swedish and Norwegian Testicular Cancer Group). PC-RPLND is not without peri- and postoperative complications even when performed in high volume centers. Previous work on this subject reflects outcome in tertiary centers. This population based prospective cohort study assesses the outcome of all PC-RPLND surgery in Sweden and Norway during a 7 year period.
The cohort consists of all patients with NSGCT in Sweden and Norway undergoing PC-RPLND from Sep 2007 to Sep 2014 at 10 different centers. 74% in the unilateral group and 60% in the bilateral group received 3-4 BEP, 23% and 39% were dose-intensified and 3% and 1% had less than 3 cycles. Preoperative tumour burden, extent of surgery- bilateral or unilateral RPLND, operation time, bleeding, and hospital stay, was recorded. The complications were graded by the Clavien-Dindo classification, ≤3a was defined as minor and ≥3b as major. The presence of retrograde ejaculation was recorded (mean FU 46 months).
Of the 268 PC-RPLND performed, 195 were uni- and 73 bilateral, of which 36% and 21% were nerve-sparing respectively. In total, 59(22%) had a minor and 9(3%) had a major complication including one death after postoperative bleeding. Other surgical procedures such as nephrectomy or v. cava resection was performed in 8% of patients. After nerve sparing RPLND 20% in the unilateral group had retrograde ejaculation compared to 36% in the non-nerve sparing group (p=0,042). For bilateral resection, corresponding results were 27% and 63% (p=0,034) (see table 1.).
This is the first population based cohort covering the postoperative complications after PC-RPLND. Surgical time, complications, retrograde ejaculation, postoperative stay and bleeding were higher in the bilateral group compared to the unilateral group.