Mosharafa Ashraf A, Foster Richard S, Koch Michael O, Bihrle Richard, Donohue John P
Department of Urology, Indiana University, Indianapolis, USA.
J Urol. 2004 May;171(5):1839-41. doi: 10.1097/01.ju.0000120141.89737.90.
Post-chemotherapy retroperitoneal lymph node dissection (PC RPLND) is a tool in the management of testis cancer. Our impression has been that the short-term morbidity of standard PC RPLND has diminished with time. Therefore, we attempted to verify this hypothesis by evaluating the morbidity of the procedure in 2 comparable groups of patients from 2 different periods.
We compared 150 patients who underwent post-chemotherapy RPLND between July 2000 and July 2002 to 79 patients who underwent the same procedure between 1990 to 1992. All patients had clinical stage II-III testis cancer and had received 3 to 4 courses of standard platinum based chemotherapy before surgery. We compared surgical morbidity and postoperative complications in both groups. We also assessed a number of factors (patient characteristics, mass size, pathological features and surgical aspects) that could impact the rate of complications.
The 2 groups were comparable regarding preoperative clinical stage, patient characteristics and postoperative pathological findings. PC RPLND procedures were performed using the same technique. Compared to patients in the 1990 to 1992 group, the patients from the 2000 to 2002 group had fewer intraoperative complications and additional procedures (44 [29.3%] of 150 versus 41 [51.9%] of 79, p = 0.0008), a trend toward a lower postoperative complication rate (10 [6.7%] compared to 11 [13.9%], p = 0.07) and shorter hospital stay (average 5.6 versus 8.4 days [p <0.0001]).
With time morbidity and hospital stay after standard PC RPLND have decreased. This finding probably reflects differences in patterns of care rather than changes in surgical technique. Therefore, comparing newer surgical techniques to historical controls is inappropriate since differences may not actually represent the technical advances of the newer procedure.
化疗后腹膜后淋巴结清扫术（PC RPLND）是睾丸癌治疗中的一种手段。我们的印象是，标准PC RPLND的短期发病率随时间有所降低。因此，我们试图通过评估来自两个不同时期的两组可比患者的手术发病率来验证这一假设。
我们将2000年7月至2002年7月期间接受化疗后RPLND的150例患者与1990年至1992年期间接受相同手术的79例患者进行了比较。所有患者均为临床II - III期睾丸癌，术前接受了3至4个疗程的标准铂类化疗。我们比较了两组的手术发病率和术后并发症。我们还评估了一些可能影响并发症发生率的因素（患者特征、肿块大小、病理特征和手术方面）。
两组在术前临床分期、患者特征和术后病理结果方面具有可比性。PC RPLND手术采用相同技术。与1990年至1992年组的患者相比，2000年至2002年组的患者术中并发症和额外手术较少（150例中的44例[29.3%]对79例中的41例[51.9%]，p = 0.0008），术后并发症发生率有降低趋势（分别为10例[6.7%]和11例[13.9%]，p = 0.07），住院时间更短（平均5.6天对8.4天[p <0.0001]）。
随着时间推移，标准PC RPLND后的发病率和住院时间有所下降。这一发现可能反映了护理模式的差异，而非手术技术的变化。因此，将新的手术技术与历史对照进行比较并不合适，因为差异可能实际上并不代表新手术的技术进步。
