Are we missing an important point? Risk factors for intraoperative complications and additional procedures when performing post-chemotherapy RPLND for testicular tumors

Purpose This study aims to investigate the risk factors associated with additional intraoperative procedures during post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in patients with advanced germ-cell tumors. Materials and Methods We retrospectively analyzed the data of 206 patients who underwent PC-RPLND for advanced germ-cell tumors between January 1990 and December 2022. Additional intraoperative procedures were defined as surgical interventions necessitated by injuries to intestinal, ureteral, major vascular, or renal vascular structures, as well as planned en-bloc resections. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of these additional procedures. Results A total of 67 additional procedures were performed in 56 patients (27.2%). The most frequent interventions were vascular procedures (aortic, caval, or renal vessel repairs), occurring in 40 patients (19.4%). This was followed by en-bloc nephrectomy in 10 (4.9%), intestinal injury repair in 9 (4.4%), and ureteral injury repair in 8 (3.9%) patients. Multivariate analysis revealed that tumor size at initial diagnosis (P < .05) and the presence of viable tumor in the pathology specimen (P < .05) were independent risk factors for requiring additional intraoperative procedures. Conclusion Tumor size at the time of initial diagnosis, rather than preoperative size, serves as a significant predictor for additional surgical procedures during PC-RPLND. Surgical planning should account for initial tumor burden and the likelihood of viable disease to optimize perioperative outcomes.