Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 May:91:70-6.
doi: 10.1016/j.urology.2016.01.010. Epub 2016 Jan 21.

Characterizing the Morbidity of Postchemotherapy Retroperitoneal Lymph Node Dissection for Testis Cancer in a National Cohort of Privately Insured Patients

Liam C Macleod  1 , Saneal Rajanahally  2 , Jasmir G Nayak  2 , Brodie A Parent  3 , Jorge D Ramos  4 , George R Schade  5 , Sarah K Holt  2 , Atreya Dash  2 , John L Gore  5 , Daniel W Lin  5
Affiliations

Characterizing the Morbidity of Postchemotherapy Retroperitoneal Lymph Node Dissection for Testis Cancer in a National Cohort of Privately Insured Patients

Liam C Macleod et al. Urology. 2016 May.

Abstract

Objective: To characterize morbidity of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testis cancer, we analyze a contemporary national database. PC-RPLND is the standard for residual radiographic masses ≥1 cm (nonseminoma) and positron emission tomography-avid masses ≥3 cm (seminoma). Morbidity for PC-RPLND is greater than primary RPLND, which may be mitigated by performing surgery at a high-volume cancer center.

Methods: Current Procedural Terminology and International Classification of Diseases, Ninth Edition codes identified men with testis cancer undergoing PC- or primary RPLND in MarketScan (2007-2012). Multivariable logistic regression assessed factors associated with receiving adjunctive procedures (ie, nephrectomy, vascular reconstruction), prolonged hospitalization, and 90-day readmission. Geographic variables assessed regionalization of PC-RPLND.

Results: Of 559 men with claims for PC- or primary RPLND (206, 37% PC-RPLND), 19% of PC-RPLND underwent adjunctive procedures (vs 1% among RPLND, P < .01). For PC-RPLND, the nephrectomy rate was 10% and the vascular reconstruction rate was 8%. On multivariable analysis, PC-RPLND was associated with undergoing adjunctive procedures (odds ratio 41.9; 95% confidence interval 11.7, 150) and prolonged hospitalization (odds ratio 3.75; 95% confidence interval 1.68, 8.42) compared to primary RPLND. PC-RPLND was not associated with 90-day readmission. Up to 29% of PC-RPLNDs are performed in centers, billing just a single case through MarketScan in the 6 years studied.

Conclusion: PC-RPLND is associated with adjunctive procedures and longer hospitalizations. Given the morbidity of PC-RPLND in this young patient population, efforts are needed to establish quality benchmarks for, reduce the morbidity of, and to accurately discriminate risk during patient discussions prior to this complex, specialized surgery.

PubMed Disclaimer

References

    1. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Cronin KA. SEER Cancer Statistics Review, 1975–2010. Bethesda, MD: National Cancer Institute; 2013.
    1. Motzer RJ, Agarwal N, Beard C, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Testicular Cancer. Vol. 2. Fort Washington, PA: National Comprehensive Cancer Network; 2015. - PubMed
    1. Hartmann JT, Schmoll HJ, Kuczyk MA, Candelaria M, Bokemeyer C. Postchemotherapy resections of residual masses from metastatic non-seminomatous testicular germ cell tumors. Ann Oncol. 1997;8:531–538. - PubMed
    1. Daneshmand S, Albers P, Fossa SD, et al. Contemporary management of postchemotherapy testis cancer. Eur Urol. 2012;62:867–876. - PubMed
    1. Baniel J, Foster RS, Rowland RG, Bihrle R, Donohue JP. Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol. 1995;153:976–980. - PubMed