Characterizing the Morbidity of Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Testis Cancer in a National Cohort of Privately Insured Patients.

Publication Type:

Journal Article

Source:

Urology (2016)

Abstract:

OBJECTIVE: To characterize morbidity of post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) for testis cancer we analyze a contemporary national database. PC-RPLND is the standard for residual radiographic masses ≥ 1 cm (non-seminoma) and PET-avid masses ≥ 3 cm (seminoma). Morbidity for PC-RPLND is greater than primary RPLND, which may be mitigated by performing surgery at a high volume cancer center.

METHODS: Current procedural terminology (CPT) and international classification of diseases 9(th) edition (ICD-9) codes identified men with testis cancer undergoing PC- or primary RPLND in MarketScan (2007-2012). Multivariable logistic regression assessed factors associated with receiving adjunctive procedures (i.e., nephrectomy, vascular reconstruction), prolonged hospitalization, and 90-day readmission. Geographic variables assessed regionalization of PC-RPLND.

RESULTS: Of 559 men with claims for PC- or primary RPLND (206, 37% PC-RPLND), 19% of PC-RPLND underwent adjunctive procedures (versus 1% among RPLND, p <0.01). For PC-RPLND, the nephrectomy rate was 10% and the vascular reconstruction rate was 8%. On multivariable analysis PC-RPLND was associated undergoing adjunctive procedures (OR 41.9, 95% CI 11.7, 150) and prolonged hospitalization (OR 3.75; 95% CI 1.68, 8.42) compared to primary RPLND. PC-RPLND was not associated with 90-day readmission. Up to 29% of PC-RPLNDs are performed in centers billing just a single case through MarketScan in the 6 years studied.

CONCLUSIONS: PC-RPLND is associated with adjunctive procedures and longer hospitalizations. Given the morbidity of PC-RPLND in this young patient population, efforts are needed to establish quality benchmarks for, reduce the morbidity of, and to accurately discriminate risk during patient discussions prior to this complex, specialized surgery.