Implementing High-Quality Retroperitoneal Lymph Node Dissection for Testicular Cancer at an Australian Tertiary Hospital: Challenging the Centralisation Paradigm in High-Need Areas
Year: 2025
Type: article
Abstract: Background: Retroperitoneal lymph node dissection (RPLND) plays an integral role in the curative management of metastatic testicular cancer. As a major surgery, RPLND poses a risk of significant complications, particularly in the post-chemotherapy (PC-RPLND) setting. We assessed the safety of introducing RPLND as a new service at an Australian tertiary hospital. Methods: A strict protocol prioritising appropriate case selection, multidisciplinary surgical expertise and ready access to intensive care facilities was implemented to introduce RPLND. Prospective data was collected on patients who underwent PC-RPLND between October 2020 and October 2022 at the Northern Hospital in Melbourne. Primary and secondary endpoints were 30-day postoperative Clavien-Dindo (CD) classification complication rate and perioperative quality measures, respectively. Results: Six patients (mean age 28.7 ± 4.3 years) underwent bilateral template open PC-RPLND. Median node count was 17 (IQR = 16) with metastatic germ cell tumour identified in all patients on histopathology. Median length of stay was 6 days (IQR = 3) with 1 day in intensive care. No blood transfusions were required, and no 30-day CD complications were encountered. Median follow-up was 22 months (IQR = 21) with no recurrences or significant delayed complications. Conclusion: Following a strict protocol, RPLND has been safely introduced as a new service at our tertiary institution. Perioperative quality endpoints match those of high-volume international centres.
Source: Research and Reports in Urology
DOI: 10.2147/rru.s474281
Institutions: The University of Melbourne, Northern Health, Northern Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,320
OpenAlex ID: W4408298704