Pyrgidis Nikolaos, Apfelbeck Maria, Kidess Marc, Weinhold Philipp, Marcon Julian, Schulz Gerald B, Volz Yannic, Ebner Benedikt, Sparwasser Peter Maximilian, Tsaur Igor, Hentrich Marcus, Stief Christian G, Chaloupka Michael
Department of Urology, University Hospital LMU Munich, Munich, Germany.
Department of Urology, University Hospital Tübingen, Tübingen, Germany.
Int J Cancer. 2025 Oct 1;157(7):1333-1341. doi: 10.1002/ijc.35486. Epub 2025 Jun 4.
We aimed to assess the current trends and outcomes of retroperitoneal lymph node dissection (RPLND) in patients with testicular cancer in Germany, as well as to provide evidence on the role of the type of surgical approach, prior chemotherapy, and annual hospital caseload. We used the GeRmAn Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005-2022). We assessed trends and perioperative outcomes (mortality, intensive care unit [ICU] admission, transfusion, acute embolism, and length of hospital stay) based on the surgical approach (robotic, laparoscopic, and open), prior chemotherapy, and annual hospital caseload (with cut-offs of three and 10 cases/year) with a multivariable regression analysis. Overall, 6673 patients underwent RPLND for testicular cancer. Of them, 5570 (83%) received open, 819 (12%) laparoscopic, and 284 (5%) robot-assisted surgery. Patients had previously received chemotherapy in 1908 (29%) cases. Accordingly, 4431 (66%) patients underwent surgery in centers performing more than 3 cases/year, and 1325 (20%) in centers performing more than 10 cases/year. Over the past 18 years, the number of patients undergoing RPLND has decreased by half. In the multivariate regression analysis, a robotic and a laparoscopic approach was associated with lower odds of ICU admission, transfusion, and shorter hospital stay (p < .001) compared to an open approach. Patients undergoing surgery after prior chemotherapy presented similar perioperative outcomes compared to those who had not previously received chemotherapy. Similarly, patients undergoing surgery at high-volume centers presented comparable perioperative outcomes to those in low-volume centers based on the cut-off of three and 10 cases/year. Still, our findings were mitigated by selection bias. Overall, the number of annual RPLND cases in Germany has decreased over time.
我们旨在评估德国睾丸癌患者腹膜后淋巴结清扫术（RPLND）的当前趋势和结果，并提供有关手术方式类型、既往化疗以及年度医院病例数量作用的证据。我们使用了由联邦统计局研究数据中心提供的德国全国住院患者数据（2005 - 2022年）。我们基于手术方式（机器人辅助、腹腔镜和开放手术）、既往化疗以及年度医院病例数量（以每年3例和10例为分界点），通过多变量回归分析评估了趋势和围手术期结果（死亡率、重症监护病房[ICU]收治率、输血、急性栓塞和住院时间）。总体而言，6673例患者接受了睾丸癌的RPLND。其中，5570例（83%）接受了开放手术，819例（12%）接受了腹腔镜手术，284例（5%）接受了机器人辅助手术。1908例（29%）患者此前接受过化疗。相应地，4431例（66%）患者在每年进行超过3例手术的中心接受手术，1325例（20%）患者在每年进行超过10例手术的中心接受手术。在过去18年中，接受RPLND的患者数量减少了一半。在多变量回归分析中，与开放手术相比，机器人辅助和腹腔镜手术方式与更低的ICU收治率、输血率以及更短的住院时间相关（p < 0.001）。与未接受过化疗的患者相比，接受过化疗后进行手术的患者围手术期结果相似。同样，基于每年3例和10例的分界点，在高病例数量中心接受手术的患者与在低病例数量中心接受手术的患者围手术期结果相当。不过，我们的研究结果受到选择偏倚的影响。总体而言，德国每年RPLND病例数量随时间减少。
