A Contemporary Review of Perioperative Metrics of Retroperitoneal Lymph Node Dissection for Testicular Cancer - the Brigham Experience
Zhiyu (Jason) Qian, MD, Vincent D'Andrea, MD, Kendrick Yim, MD, Benjamin V. Stone, MD, Jillian Egan, MD, Jerome Richie, MD, Graeme Steele, MD, Mark Preston, MD, Matthew Mossanen, MD, Timothy Clinton, MD.
Brigham and Women's Hospital, Boston, MA, USA.
Introduction and Objective: Retroperitoneal lymph node dissection (RPLND) is an essential component of multimodal treatment for testicular cancer. The latest data on the perioperative outcomes of open RPLNDs (O-RPLND) were reported more than a decade ago, and an update is needed. In this study, we report our contemporary institutional perioperative outcomes with O-RPLND.Methods: We retrospectively identified all patients who underwent O-RPLND between 2013 and 2022 in our institution. Clinical and demographic data were reviewed and recorded. Descriptive statistics and univariate analysis were performed, with patients stratified according to primary RPLND and post-chemotherapy RPLND (PC-RPLND).
Results: Our cohort included a total of 144 men, with 77% of cases being PC-RPLND. The PC-RPLND cohort showed higher pre-operative N and clinical stages (81% vs. 26% above cN1, p <0.001; 41% vs. 1% Stage 3, p<0.001). The pathology in PC-RPLND cases was more likely to be teratoma and necrosis or fibrosis (43% vs. 6% and 39% vs. 33%, p<0.001). The estimated blood loss was significantly higher in the PC-RPLND group (291 vs. 125 cc, p=0.004). The operative time was longer in PC-RPLND (242 vs. 196 minutes, p=0.011). The length of stay and 30-day readmission rate were not significantly different between groups and averaged at 4.3 days and 12%, respectively. Our most common complication was ileus (5%), followed by chyle leak (3%).Conclusions: Despite the growing weight of PC-RPLND for more advanced diseases, our contemporary cohort saw a decrease in blood loss and length of stay while maintaining other favorable perioperative outcomes. With long-term outcome data needed to appropriately select patients for robotic RPLND, O-RPLND in experienced hands continues to improve its outcomes and remains the standard approach in the modern era.
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