Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
McGovern Medical School, University of Texas, Houston, Texas.
Cancer. 2020 Nov 15;126(22):4878-4885. doi: 10.1002/cncr.33051. Epub 2020 Sep 17.
Postchemotherapy retroperitoneal lymphadenectomy (PC-RPLND) is an essential, yet potentially morbid, therapy for the management of patients with advanced germ cell tumors. In the current study, the authors sought to define the complication profile of PC-RPLND using validated grading systems for intraoperative adverse events (iAEs) and early postoperative complications.
Between 2000 and 2018, all patients who underwent PC-RPLND were analyzed for iAEs and early postoperative complications using the Kaafarani and Clavien-Dindo classifications, respectively. Logistic regression models were conducted to assess patient and tumor factors associated with iAEs and postoperative complications.
Of the 453 patients identified, 115 patients (25%) and 252 patients (56%), respectively, experienced an iAE and postoperative complication. Major iAEs (grade ≥3) were observed in 15 patients (3%) and major postoperative complications (grade ≥3) were noted in 80 patients (18%). The most common iAE was vascular injury (112 of 132 events; 85%), which occurred in 92 patients (20%), and the most frequent postoperative complication was ileus, which occurred in 121 patients (27%). Original and postchemotherapy retroperitoneal mass size, nonretroperitoneal metastases, intermediate and/or poor International Germ Cell Cancer Collaborative Group classification, previous RPLND, elevated tumor markers at the time of RPLND, and anticipated adjuvant surgical procedures increased the risk of both iAEs and postoperative complications. Patients who experienced an iAE were significantly more likely to experience a postoperative complication (odds ratio, 2.50; 95% confidence interval, 1.58-3.97 [P < .001]).
In what to the authors' knowledge is the first analysis of PC-RPLND using validated classifications for both iAEs and postoperative complications, advanced disease and surgical complexity significantly increased the risks of major iAEs and postoperative complications. Standardized reporting of adverse perioperative events allows providers and patients to appreciate the consequences of PC-RPLND during counseling and decision making.
化疗后腹膜后淋巴结清扫术（PC-RPLND）是治疗晚期生殖细胞肿瘤患者的重要手段，但也可能带来严重的并发症。本研究旨在使用术中不良事件（iAE）和早期术后并发症的验证分级系统来定义 PC-RPLND 的并发症谱。
在 2000 年至 2018 年期间，使用 Kaafarani 和 Clavien-Dindo 分类法分别分析了所有接受 PC-RPLND 的患者的 iAE 和早期术后并发症。采用逻辑回归模型评估了与 iAE 和术后并发症相关的患者和肿瘤因素。
在 453 例患者中，分别有 115 例（25%）和 252 例（56%）患者发生了 iAE 和术后并发症。15 例（3%）发生了严重的 iAE（分级≥3），80 例（18%）发生了严重的术后并发症（分级≥3）。最常见的 iAE 是血管损伤（132 例事件中的 112 例；85%），发生在 92 例患者中（20%），最常见的术后并发症是肠梗阻，发生在 121 例患者中（27%）。原发和化疗后腹膜后肿块大小、非腹膜后转移、中间和/或不良国际生殖细胞癌协作组分类、先前的 RPLND、RPLND 时肿瘤标志物升高以及预期的辅助手术均增加了 iAE 和术后并发症的风险。发生 iAE 的患者发生术后并发症的风险显著增加（优势比，2.50；95%置信区间，1.58-3.97[P<0.001]）。
这是首次使用 iAE 和术后并发症的验证分类来分析 PC-RPLND，高级别疾病和手术复杂性显著增加了严重 iAE 和术后并发症的风险。对围手术期不良事件的标准化报告使提供者和患者能够在咨询和决策过程中了解 PC-RPLND 的后果。
