Perioperative outcomes in testicular cancer patients treated with retroperitoneal lymph node dissection

Objective: No large-scale population-based studies quantified perioperative outcomes in testicular cancer (TC) patients treated with retroperitoneal lymph node dissection (RPLND), especially in non-metastatic and metastatic stages. Moreover, no previous studies compared outcomes in centers of excellence (Indiana University School of Medicine, Memorial Sloan Kettering Cancer Center, and MD Anderson Cancer Center) vs. large-scale population-based databases. Methods: Using the National Inpatient Sample (2000–2015), we identified TC patients undergoing RPLND. Patient, tumor, and hospital characteristics were tested in two separate multivariable models addressing overall complications and length of hospital stay (LOS). Critical care therapy and in-hospital mortality rates were also quantified. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results: In 1,988 non-metastatic patients overall complications were recorded in 469 (23.6%) vs. 758 (34.3%) in 2,213 metastatic RPLND patients. The rates of RPLND as well as the overall complications did not change during the study period. LOS increased by two days in both non-metastatic (4 vs. 6 days) and metastatic stages (5 vs. 7 days) in the presence of complications. In multivariable logistic regression models neither teaching hospital status nor hospital bed-size were predictors of overall complications. Conclusion: RPLND patients should be informed about a 1:4 chance of overall complications in non-metastatic settings and of a 1:3 chance of overall complications in metastatic settings. Moreover, complication rates in population-based repertories are 2- to 4-fold higher than centers of excellence.