Surgical Complications in Postchemotherapy Retroperitoneal Lymph Node Dissection for Nonseminoma Germ Cell Tumour: A Population-based Study from the Swedish Norwegian Testicular Cancer Group

• Published in: European urology oncology 2020, Vol.3 (3), p.382-389
• Main Authors: Gerdtsson, Axel, Håkansson, Ulf, Törnblom, Magnus, Jancke, George, Negaard, Helene F.S., Glimelius, Ingrid, Halvorsen, Dag, Karlsdóttir, Ása, Haugnes, Hege Sagstuen, Andreassen, Kristine Engen, Larsen, Signe Melsen, Holmberg, Göran, Wahlqvist, Rolf, Tandstad, Torgrim, Cohn-Cedermark, Gabriella, Ståhl, Olof, Kjellman, Anders
• Format: Article
• Language: English
• Subjects: Cancer and Oncology; Cancer och onkologi; Clinical Medicine; Complications; Kirurgi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Nonseminoma; Postchemotherapy retroperitoneal lymph node dissection; Retrograde ejaculation; Surgery; Testicular cancer; Urologi och njurmedicin; Urology and Nephrology
• ISSN: 2588-9311; 2588-9311
• DOI: 10.1016/j.euo.2019.08.002

Reports on perioperative complications after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminoma germ cell tumour (NSGCT) are from experienced single centres, with a lack of population-based studies. To assess the complications of bilateral and unilateral PC-RPLND. A prospective, population-based, observational multicentre study included all patients with NSGCT who underwent PC-RPLND in Norway and Sweden during 2007–2014. Of a total of 318 patients, 87 underwent bilateral PC-RPLND and 231 underwent unilateral PC-RPLND. The median follow-up was 6 yr. Bilateral and unilateral PC-RPLND were compared for the outcomes of intra- and postoperative complications (graded by Clavien-Dindo) and retrograde ejaculation (with or without nerve-sparing surgery). Complications were reported as absolute counts and percentages. The χ2 test was used for comparisons. The incidence of intraoperative complications was higher for bilateral PC-RPLND than for unilateral PC-RPLND (14% vs 4.3%, p = 0.003), with ureteral injury as the most frequent reported complication (2% of the patients). Postoperative complications were more common after bilateral than after unilateral PC-RPLND (45% vs 25%, p = 0.001) with Clavien ≥3b reported in 8.3% and 2.2%, respectively (p = 0.009). Lymphatic leakage was the most common complication occurring in 11% of the patients. Retrograde ejaculation occurred more frequently after bilateral than after unilateral surgery (59% vs 32%, p