Outcomes of Postchemotherapy Retroperitoneal Lymph Node Dissection from a High-volume UK Centre Compared with a National Data Set.
Outcomes of Postchemotherapy Retroperitoneal Lymph Node Dissection from a High-volume UK Centre Compared with a National Data Set.
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DOI：
10.1016/j.euros.2021.09.005
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发表时间：
2021-11
影响因子：
2.5
通讯作者：
Nicol DL
中科院分区：
文献类型：
--
作者：
Pearce AK;Manson-Bahr D;Reid A;Huddart R;Mayer E;Nicol DL
腹膜后淋巴结清扫术（RPLND）对于治疗睾丸转移性生殖细胞肿瘤至关重要。关于英国复杂泌尿系统癌症的转诊和管理的建议包括将服务集中到区域中心。回顾具有复杂病例组合的大容量中心的当代 PC-RPLND 结果，并与国家登记数据进行比较。我们回顾性审查了 2012 年 7 月至 2018 年 9 月期间在我们中心进行的生殖细胞肿瘤 PC-RPLND 的医疗记录。主要结果是 Clavien 3+ 并发症、组织学、阳性切缘率、复发、现场复发和死亡率。次要结局是失血量、手术时间、输血、辅助手术、住院时间和淋巴结计数。将所有睾丸癌 RPLND 的手术和组织学结果与国家 RPLND 登记数据进行比较。对于统计学差异，采用χ2检验。总共进行了 178 例手术，其中包括 31 例（17%）重做 RPLND。 Clavien 3+ 并发症发生率为 11 例 (7%)。非重做病例的组织学结果如下：坏死 24%，畸胎瘤 62%，活生殖细胞肿瘤 11%，去分化癌 3%。切缘阳性率、复发率和现场复发率分别为 11%、17% 和 2%。中位生存期为 36 个月，总生存率为 89%。中位失血量为 650ml (350, 1250)，输血率为 8%。需要进行肾切除术、血管重建术和内脏切除术的比例分别为 12%、6% 和 3%。中位住院时间为 6 天 (5, 8)，中位淋巴结计数为 35 (20, 37)。所有 RPLND 与国家数据的比较显示主要结局没有统计学差异。我们的输血率明显较低（12% vs 21%，χ2 [1, N = 322] = 4.296，p = 0.038）。集中化导致了英国 RPLND 的高质量。其中，我们的系列（英国最大的系列）表明，尽管案例复杂性较高，但结果没有显着差异。我们的输血率实际上低于全国数字。复杂的 RPLND 应尽可能在高容量中心进行。在英国，腹膜后淋巴结清扫术（RPLND）集中于专科中心，手术质量高，并发症低，组织学结果良好。与国家数据相比，我们发现尽管病例组合复杂，但我们大容量中心的大多数结果没有显着差异。这是英国最大的化疗后腹膜后淋巴结清扫术 (RPLND) 系列。集中化导致全国范围内 RPLND 的高标准、仅针对坏死进行的 RPLND 比例较低以及大容量中心的发展。高容量中心的好处如下：尽管复杂病例比例较高且输血率降低，但大多数结果没有显着差异；输血与许多恶性肿瘤的较差肿瘤学结果有关。
Retroperitoneal lymph node dissection (RPLND) is essential for the treatment of metastatic germ cell tumours of the testis. Recommendations on the referral and management of complex urological cancers in the UK includes centralisation of services to regional centres. To review contemporary PC-RPLND outcomes at a high-volume centre with a complex case-mix, and compare with national registry data. We retrospectively reviewed the medical records of PC-RPLNDs performed for germ cell tumours at our centre between July 2012 and September 2018. Primary outcomes were Clavien 3+ complications, histology, rates of positive margin, relapse, in-field recurrences, and mortality. Secondary outcomes were blood loss, operation time, blood transfusion, adjuvant procedures, length of stay, and lymph node count. Surgical and histological outcomes of all RPLNDs for testicular cancers were compared with national RPLND registry data. For statistical difference, χ2 testing was used. A total of 178 procedures were performed, including 31 (17%) redo RPLNDs. Clavien 3+ complications occurred in 11 (7%). Histological findings in non-redo cases were the following: necrosis 24%, teratoma 62%, viable germ cell tumour 11%, and dedifferentiated cancers 3%. Rates of positive margin, relapse, and in-field recurrence were 11%, 17%, and 2%, respectively. Overall survival was 89% at a median of 36 mo. The median blood loss was 650 ml (350, 1250), with a transfusion rate of 8%. Nephrectomy, vascular reconstruction, and visceral resection was required in 12%, 6%, and 3% respectively. The median inpatient stay was 6 d (5, 8) and the median node count was 35 (20, 37). A comparison of all RPLNDs with national data showed no statistical difference in primary outcomes. Our blood transfusion rate was significantly lower (12% vs 21%, χ2 [1, N = 322] = 4.296, p = 0.038). Centralisation led to high quality of RPLND in UK. Within that, our series (the largest in the UK) demonstrates no significant difference in outcomes despite higher complexity cases. Our blood transfusion rates are in fact lower than national figures. Complex RPLNDs should be performed in high-volume centres where possible. In the UK, retroperitoneal lymph node dissections (RPLND) are centralised to specialist centres and the quality of surgery is high, with low complications and good histological outcomes. When compared to national data, we found no significant difference in the majority of outcomes from our high-volume centre despite our complex case-mix. This is the largest postchemotherapy retroperitoneal lymph node dissection (RPLND) series in the UK. Centralisation has led to a high standard of RPLNDs nationally, lower proportion of RPLNDs performed for necrosis only, and the evolution of high-volume centres. The benefits of high volume centres are the following: no significant difference in the majority of outcomes despite the higher proportion of complex cases and a reduced blood transfusion rate; transfusion is linked to poorer oncological outcomes in a number of malignancies.
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