Available online 9 May 2025, 102228

First RPLND series applying EAU guidelines for standardized complication reporting

⁠96% of patients had at least one postoperative complication but major events were rare

Comprehensive Complication Index (CCI) revealed higher complication burden than Clavien-Dindo classification alone (14% vs. 8.5%)

⁠Most common complications were anemia and gastrointestinal issues

⁠Findings enhance patient counseling on treatment-related morbidity in testicular cancer

Retroperitoneal lymph node dissection (RPLND) is crucial in managing metastatic germ cell tumors (GCTs), particularly post-chemotherapy. Given the long-term survival of these patients, perioperative morbidity is a significant concern. However, data on RPLND morbidity using predefined reporting standards are scarce. This study aims to address this gap by utilizing updated EAU guidelines for standardized complication reporting.

A retrospective analysis was conducted on patients who underwent RPLND for GCTs between 2010–2022. 30-day complications were extracted from digital charts using a predefined procedure-specific catalog. Complications were graded using the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI) was calculated for each patient.

Sixty-nine men underwent RPLND at a median age of 32 years (IQR 25-38). Chemotherapy was administered to 64 patients (93%), with 48 (70%) having negative tumor markers. Median tumor diameter was 52 mm (IQR 35-83), and median operative time was 197 min (IQR 128-262). Unilateral template removal was performed in 55 patients (80%). A total of 157 complications were reported in 66 patients (96%), with anemia (33%) and gastrointestinal issues (24%) being the most common. Five patients (7.2%) had “major” complications (CDC grade ≥IIIa), and the median CCI was 12 (IQR 9-23). Using the CCI, the proportion of patients with a “major” complication burden increased to 14%, compared to 8.5% by CDC alone. The primary limitation of this study is its retrospective design and the limited 30-day follow-up period.

Most patients experience postoperative complications after RPLND, though severe complications are rare. These findings could improve patient counseling when discussing testicular cancer therapy options.

(MeSH): Clavien-Dindo classification

Comprehensive Complication Index

Guideline Adherence

Lymph Node Excision

Postoperative Complications

Testicular Neoplasms

© 2025 The Authors. Published by Elsevier Ltd.