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Complications and clinical outcomes of retroperitoneal lymph node dissection for testicular cancer in a centralized population-based cohort in Sweden : insights from SWENOTECA

Thor, Anna ; Bergdahl, Anna Grenabo ; Abniki, Armin ; Gerdtsson, Axel LU ; Glimelius, Ingrid ; Hellström, Martin ; Jansson, Anna K. ; Johannsdottir, Berglind ; Tandstad, Torgrim and Cohn-Cedermark, Gabriella , et al. (2026) In Scandinavian Journal of Urology 61. p.112-120
Abstract

Objective: Retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancer is a complex procedure associated with postoperative complications and long-term morbidity, best performed by experienced surgeons at high-volume centers. This study evaluates surgical outcomes of RPLND in a centralized population-based cohort. Methods: This is a retrospective analysis of a prospective multicenter cohort of all RPLNDs in Sweden between 2018 and 2022. 217 patients (175 nonseminomas and 42 seminomas) underwent unilateral or bilateral primary RPLND or post-chemotherapy RPLND. Primary outcomes were complications, loss of ejaculation, and histopathology. Results: Intraoperative complications occurred in 8% of unilateral and 0% of... (More)

Objective: Retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancer is a complex procedure associated with postoperative complications and long-term morbidity, best performed by experienced surgeons at high-volume centers. This study evaluates surgical outcomes of RPLND in a centralized population-based cohort. Methods: This is a retrospective analysis of a prospective multicenter cohort of all RPLNDs in Sweden between 2018 and 2022. 217 patients (175 nonseminomas and 42 seminomas) underwent unilateral or bilateral primary RPLND or post-chemotherapy RPLND. Primary outcomes were complications, loss of ejaculation, and histopathology. Results: Intraoperative complications occurred in 8% of unilateral and 0% of bilateral templates in primary RPLND, and in 0 and 8% in post-chemotherapy RPLND, most commonly renal injury. Postoperative complications rate was significantly higher with bilateral templates in post-chemotherapy RPLND (49% vs 18%, p < 0.01). Clavien-Dindo ≥ IIIb complications occurred in 2 (primary) and 3% (post-chemotherapy), respectively. Loss of ejaculation was numerically more common after bilateral templates (primary: 60% vs 31%, p = 0.07; post-chemotherapy: 53% vs 38%, p = 0.09). Viable cancer was found in 95% of seminomas and 52% of nonseminomas for primary RPLND and in nonseminoma post-chemotherapy RPLND, 11% viable cancer, 50% teratoma, and 39% benign nodes. Robotic surgery did not increase complications or loss of ejaculation. Conclusions: RPLND demonstrated low complication rates and rare serious events. Bilateral templates were associated with increased loss of ejaculation. Robotic surgery was safe, and prior chemotherapy did not preclude laparoscopy. Post-chemotherapy RPLND showed more teratoma and viable cancer, and fewer benign findings than previously reported.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Complications, germ cell cancer, metastatic, nonseminoma, retroperitoneal, robotic surgery, RPLND, seminoma, testicular
in
Scandinavian Journal of Urology
volume
61
pages
9 pages
publisher
Taylor & Francis
external identifiers
  • scopus:105035570713
  • pmid:41969137
ISSN
2168-1805
DOI
10.2340/sju.v61.45743
language
English
LU publication?
yes
id
ef86330b-7a34-4f69-8d25-fc08ed2fb9d4
date added to LUP
2026-06-29 12:30:50
date last changed
2026-07-14 19:18:02
@article{ef86330b-7a34-4f69-8d25-fc08ed2fb9d4,
  abstract     = {{<p>Objective: Retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancer is a complex procedure associated with postoperative complications and long-term morbidity, best performed by experienced surgeons at high-volume centers. This study evaluates surgical outcomes of RPLND in a centralized population-based cohort. Methods: This is a retrospective analysis of a prospective multicenter cohort of all RPLNDs in Sweden between 2018 and 2022. 217 patients (175 nonseminomas and 42 seminomas) underwent unilateral or bilateral primary RPLND or post-chemotherapy RPLND. Primary outcomes were complications, loss of ejaculation, and histopathology. Results: Intraoperative complications occurred in 8% of unilateral and 0% of bilateral templates in primary RPLND, and in 0 and 8% in post-chemotherapy RPLND, most commonly renal injury. Postoperative complications rate was significantly higher with bilateral templates in post-chemotherapy RPLND (49% vs 18%, p &lt; 0.01). Clavien-Dindo ≥ IIIb complications occurred in 2 (primary) and 3% (post-chemotherapy), respectively. Loss of ejaculation was numerically more common after bilateral templates (primary: 60% vs 31%, p = 0.07; post-chemotherapy: 53% vs 38%, p = 0.09). Viable cancer was found in 95% of seminomas and 52% of nonseminomas for primary RPLND and in nonseminoma post-chemotherapy RPLND, 11% viable cancer, 50% teratoma, and 39% benign nodes. Robotic surgery did not increase complications or loss of ejaculation. Conclusions: RPLND demonstrated low complication rates and rare serious events. Bilateral templates were associated with increased loss of ejaculation. Robotic surgery was safe, and prior chemotherapy did not preclude laparoscopy. Post-chemotherapy RPLND showed more teratoma and viable cancer, and fewer benign findings than previously reported.</p>}},
  author       = {{Thor, Anna and Bergdahl, Anna Grenabo and Abniki, Armin and Gerdtsson, Axel and Glimelius, Ingrid and Hellström, Martin and Jansson, Anna K. and Johannsdottir, Berglind and Tandstad, Torgrim and Cohn-Cedermark, Gabriella and Kjellman, Anders and Lundgren, Per Olof}},
  issn         = {{2168-1805}},
  keywords     = {{Complications; germ cell cancer; metastatic; nonseminoma; retroperitoneal; robotic surgery; RPLND; seminoma; testicular}},
  language     = {{eng}},
  pages        = {{112--120}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Complications and clinical outcomes of retroperitoneal lymph node dissection for testicular cancer in a centralized population-based cohort in Sweden : insights from SWENOTECA}},
  url          = {{http://dx.doi.org/10.2340/sju.v61.45743}},
  doi          = {{10.2340/sju.v61.45743}},
  volume       = {{61}},
  year         = {{2026}},
}