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

Authors

  • Anna Thor Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0003-2915-1761
  • Anna Grenabo Bergdahl Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenburg, Sweden https://orcid.org/0000-0003-3266-7611
  • Armin Abniki Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
  • Axel Gerdtsson Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden https://orcid.org/0000-0003-4033-5078
  • Ingrid Glimelius Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0001-6158-3041
  • Martin Hellström Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
  • Anna K. Jansson Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden https://orcid.org/0000-0001-6305-9729
  • Berglind Johannsdottir Department of Oncology – Pathology, Karolinska Institute, Stockholm, Sweden https://orcid.org/0000-0002-2236-1718
  • Torgrim Tandstad Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway https://orcid.org/0000-0002-9786-2138
  • Gabriella Cohn-Cedermark Department of Oncology – Pathology, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-5681-5829
  • Anders Kjellman Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-9080-9027
  • Per-Olof Lundgren Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0001-7976-6962

DOI:

https://doi.org/10.2340/sju.v61.45743

Keywords:

Complications, germ cell cancer, metastatic, nonseminoma, retroperitoneal, robotic surgery, RPLND, seminoma, testicular

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 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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Published

2026-04-13

How to Cite

Thor, A., Grenabo Bergdahl, A., Abniki, A., Gerdtsson, A., Glimelius, I., Hellström, M., … Lundgren, P.-O. (2026). Complications and clinical outcomes of retroperitoneal lymph node dissection for testicular cancer in a centralized population-based cohort in Sweden: insights from SWENOTECA. Scandinavian Journal of Urology, 61(1), 112–120. https://doi.org/10.2340/sju.v61.45743

Issue

Vol. 61 (2026)

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Copyright (c) 2026 Anna Thor, Anna Grenabo Bergdahl, Armin Abniki, Axel Gerdtsson, Ingrid Glimelius, Martin Hellström, Anna K. Jansson, Berglind Johannsdottir, Torgrim Tandstad, Gabriella Cohn-Cedermark, Anders Kjellman, Per-Olof Lundgren

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As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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