Klemm Jakob, Dahlem Roland, Hartmann Michael, von Deimling Markus, Schulz Robert J, Klemm David, Janisch Florian, Shariat Shahrokh F, Fisch Margit, Vetterlein Malte W
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Surg Oncol. 2025 Jun;60:102228. doi: 10.1016/j.suronc.2025.102228. Epub 2025 May 9.
Retroperitoneal lymph node dissection (RPLND) is crucial in managing metastatic germ cell tumors (GCTs), particularly post-chemotherapy. Given the long-term survival of these patients, perioperative morbidity is a significant concern. However, data on RPLND morbidity using predefined reporting standards are scarce. This study aims to address this gap by utilizing updated European Association of Urology (EAU) guidelines for standardized complication reporting.
A retrospective analysis was conducted on patients who underwent RPLND for GCTs between 2010 and 2022. 30-day complications were extracted from digital charts using a predefined procedure-specific catalog. Complications were graded using the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI) was calculated for each patient.
Sixty-nine men underwent RPLND at a median age of 32 years (IQR 25-38). Chemotherapy was administered to 64 patients (93 %), with 48 (70 %) having negative tumor markers. Median tumor diameter was 52 mm (IQR 35-83), and median operative time was 197 min (IQR 128-262). Unilateral template removal was performed in 55 patients (80 %). A total of 157 complications were reported in 66 patients (96 %), with anemia (33 %) and gastrointestinal issues (24 %) being the most common. Five patients (7.2 %) had "major" complications (CDC grade ≥ IIIa), and the median CCI was 12 (IQR 9-23). Using the CCI, the proportion of patients with a "major" complication burden increased to 14 %, compared to 8.5 % by CDC alone. The primary limitation of this study is its retrospective design and the limited 30-day follow-up period.
Most patients experience postoperative complications after RPLND, though severe complications are rare. These findings could improve patient counseling when discussing testicular cancer therapy options.
腹膜后淋巴结清扫术（RPLND）在转移性生殖细胞肿瘤（GCT）的治疗中至关重要，尤其是在化疗后。鉴于这些患者的长期生存情况，围手术期发病率是一个重大问题。然而，使用预定义报告标准的RPLND发病率数据稀缺。本研究旨在通过采用更新后的欧洲泌尿外科学会（EAU）指南进行标准化并发症报告来填补这一空白。
对2010年至2022年间接受RPLND治疗GCT的患者进行回顾性分析。使用预定义的特定手术目录从数字病历中提取30天并发症。并发症采用Clavien-Dindo分类（CDC）进行分级，并为每位患者计算综合并发症指数（CCI）。
69名男性接受了RPLND，中位年龄为32岁（四分位间距25 - 38岁）。64名患者（93%）接受了化疗，其中48名（70%）肿瘤标志物呈阴性。中位肿瘤直径为52 mm（四分位间距35 - 83 mm），中位手术时间为197分钟（四分位间距128 - 262分钟）。55名患者（80%）进行了单侧模板切除。69名患者中有66名（96%）共报告了157例并发症，其中贫血（33%）和胃肠道问题（24%）最为常见。5名患者（7.2%）出现“严重”并发症（CDC分级≥IIIa级），CCI中位数为12（四分位间距9 - 23）。使用CCI时，“严重”并发症负担患者的比例增加到14%，而仅使用CDC时为8.5%。本研究的主要局限性在于其回顾性设计以及30天的有限随访期。
大多数患者在RPLND术后会出现并发症，尽管严重并发症很少见。这些发现有助于在讨论睾丸癌治疗方案时改善患者咨询。
