Implementing High-Quality Retroperitoneal Lymph Node Dissection for Testicular Cancer at an Australian Tertiary Hospital: Challenging the Centralisation Paradigm in High-Need Areas.
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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.
期刊介绍：
Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.
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