Outcomes of retroperitoneal lymph node dissection for testicular cancer by a high volume surgeon from Australia: a case for centralisation.

Autor: Williams ISC; Specialty of Surgery, University of Sydney, Sydney, Australia., Lahoud J; Specialty of Surgery, University of Sydney, Sydney, Australia., Gurney H; Department of Medical Oncology, Westmead Hospital, Sydney, Australia., Arasaratnam M; Department of Medical Oncology, Gosford Hospital, Australia., Patel MI; Specialty of Surgery, University of Sydney, Sydney, Australia.; Department of Urology, Westmead Hospital, Westmead, Australia.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2022 May; Vol. 92 (5), pp. 1044-1049. Date of Electronic Publication: 2021 Nov 01.
DOI: 10.1111/ans.17323
Abstrakt: Background: There are few studies examining retroperitoneal lymph node dissection (RPLND) for testicular cancer in Australia. This study examines the perioperative outcomes, complications and survival rates following RPLND, by a high volume, single surgeon.
Methods: A retrospective, case series of a single surgeon, multi-centre study included all patients who underwent RPLND following testicular cancer at Westmead Public Hospital, Westmead Private Hospital, and Macquarie University Hospital 2005-2020. One hundred one patients identified, with 94 having sufficient available data.
Results: At time of operation, median age was 29.5 years. 84.2% had T1 or T2 primary tumours at diagnosis. Most common RPLND indication was residual mass post-chemotherapy (92.6%), with bleomycin, etoposide and cisplatin (BEP)x3 and BEPx4 most common chemotherapy regimens (50% and 35% respectively). Post-chemotherapy, largest residual mass ranged from 0.9 to 20 cm (median 3.32 cm). Post-chemotherapy, 95.7% masses were found in retroperitoneum (64.4% para-aortic region). 93.6% had open approach. 42.5% had bilateral nerve sparing. Majority (97.1%) did not require blood transfusion. No complications reported in 52.1% of patients. No deaths recorded within 90 days of surgery. At time of analysis, 91.5% had recurrence free survival, and 92.6% overall survival, at a median follow-up since surgery of 47.5 months (range 11 to 200 months).
Conclusions: This retrospective study, addressing peri-operative surgical outcomes for RPLND surgery in Australia, is comparable to high-volume international urological centre studies, and shows that centralisation of post-chemotherapy RPLND to an experienced surgeon, results in low perioperative morbidity and mortality.
(© 2021 Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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