Pearce Adam Kieran, Manson-Bahr David, Reid Alison, Huddart Robert, Mayer Erik, Nicol David L
Urology Dept, The Royal Marsden NHS Trust, 203 Fulham Rd, Chelsea, London, SW3 6JJ, UK.
Urology Dept, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, Qld 4006, Australia.
Eur Urol Open Sci. 2021 Sep 30;33:83-88. doi: 10.1016/j.euros.2021.09.005. eCollection 2021 Nov.
Retroperitoneal lymph node dissection (RPLND) is essential for the treatment of metastatic germ cell tumours of the testis. Recommendations on the referral and management of complex urological cancers in the UK includes centralisation of services to regional centres.
To review contemporary PC-RPLND outcomes at a high-volume centre with a complex case-mix, and compare with national registry data.
We retrospectively reviewed the medical records of PC-RPLNDs performed for germ cell tumours at our centre between July 2012 and September 2018.
Primary outcomes were Clavien 3+ complications, histology, rates of positive margin, relapse, in-field recurrences, and mortality. Secondary outcomes were blood loss, operation time, blood transfusion, adjuvant procedures, length of stay, and lymph node count. Surgical and histological outcomes of all RPLNDs for testicular cancers were compared with national RPLND registry data. For statistical difference, χ testing was used.
A total of 178 procedures were performed, including 31 (17%) redo RPLNDs. Clavien 3+ complications occurred in 11 (7%). Histological findings in non-redo cases were the following: necrosis 24%, teratoma 62%, viable germ cell tumour 11%, and dedifferentiated cancers 3%. Rates of positive margin, relapse, and in-field recurrence were 11%, 17%, and 2%, respectively. Overall survival was 89% at a median of 36 mo. The median blood loss was 650 ml (350, 1250), with a transfusion rate of 8%. Nephrectomy, vascular reconstruction, and visceral resection was required in 12%, 6%, and 3% respectively. The median inpatient stay was 6 d (5, 8) and the median node count was 35 (20, 37). A comparison of all RPLNDs with national data showed no statistical difference in primary outcomes. Our blood transfusion rate was significantly lower (12% vs 21%, χ [1, = 322] = 4.296, = 0.038).
Centralisation led to high quality of RPLND in UK. Within that, our series (the largest in the UK) demonstrates no significant difference in outcomes despite higher complexity cases. Our blood transfusion rates are in fact lower than national figures. Complex RPLNDs should be performed in high-volume centres where possible.
In the UK, retroperitoneal lymph node dissections (RPLND) are centralised to specialist centres and the quality of surgery is high, with low complications and good histological outcomes. When compared to national data, we found no significant difference in the majority of outcomes from our high-volume centre despite our complex case-mix.
腹膜后淋巴结清扫术（RPLND）对于睾丸转移性生殖细胞肿瘤的治疗至关重要。英国关于复杂泌尿系统癌症转诊和管理的建议包括将服务集中到区域中心。
回顾一家病例组合复杂的高容量中心当代保留神经的腹膜后淋巴结清扫术（PC-RPLND）的结果，并与国家登记数据进行比较。
设计、设置和参与者：我们回顾性分析了2012年7月至2018年9月期间在我们中心为生殖细胞肿瘤进行的PC-RPLND的病历。
主要结果是Clavien 3级及以上并发症、组织学、切缘阳性率、复发率、野内复发率和死亡率。次要结果是失血量、手术时间、输血情况、辅助手术、住院时间和淋巴结数量。将所有睾丸癌RPLND的手术和组织学结果与国家RPLND登记数据进行比较。对于统计学差异，采用χ检验。
共进行了178例手术，包括31例（17%）再次RPLND。Clavien 3级及以上并发症发生在11例（7%）。非再次手术病例的组织学结果如下：坏死24%，畸胎瘤62%，存活生殖细胞肿瘤11%，去分化癌3%。切缘阳性率、复发率和野内复发率分别为11%、17%和2%。中位随访36个月时总生存率为89%。中位失血量为650 ml（350，1250），输血率为8%。分别有12%、6%和3%的患者需要进行肾切除术、血管重建和内脏切除术。中位住院时间为6天（5，8），中位淋巴结数量为35个（20，37）。将所有RPLND与国家数据进行比较，主要结果无统计学差异。我们的输血率显著更低（12%对21%，χ[1，=322]=4.296，=0.038）。
在英国，集中化导致了高质量的RPLND。在此范围内，我们的系列研究（英国最大规模）表明，尽管病例更复杂，但结果无显著差异。我们的输血率实际上低于全国数据。复杂的RPLND应尽可能在高容量中心进行。
在英国，腹膜后淋巴结清扫术（RPLND）集中在专科中心，手术质量高，并发症少，组织学结果良好。与国家数据相比，尽管我们的病例组合复杂，但我们高容量中心的大多数结果无显著差异。
