Centralization tendencies of retroperitoneal lymph node dissection for testicular cancer in Germany? A total population-based analysis from 2006 to 2015
Retroperitoneal lymph node dissection (RPLND) is a standard treatment in the management of metastatic testicular cancer. Due to modified treatment algorithms, it is becoming less frequent.
Materials and methods
We analyzed data from the nationwide German hospital billing database covering 2006–2015. Cases with a testicular cancer diagnosis combined with RPLND were included. We assessed the length of hospital stay (LOS), blood transfusion, and in-hospital mortality stratified for surgical approach, hospital characteristics, and annual caseload. Annual hospital caseload categories were defined as low (< 4), medium (4–10), and high (> 10). We supplemented tumor incidence and staging data from the German cancer registry (60% of population).
4926 cases were included with decreasing annual caseload numbers from 623 in 2006 to 382 in 2015. The incidence of testicular cancer and higher tumor stages remained stable. High-volume hospitals performed 19.4%, medium-volume hospitals 43.7%, and low-volume hospitals 36.8% RPLNDs. Low- abd medium-volume hospitals declined, while high-volume hospitals (n = 5) maintained their annual caseload. Overall in-hospital mortality was 0.47%. Blood transfusion rates were higher in high-volume centers assumedly due to selection of more complex cases. However, high-volume hospitals showed a shorter LOS with 10.5 vs. 11.2 (medium volume), and 12.7 days (low volume).
Total numbers of RPLND have declined from 2006 to 2015, while tumor incidences and stages remained fairly stable. Constant reduction of indication in guidelines contributes to this finding. High-volume hospitals achieve shorter hospital stays in spite of assumedly more complex and extensive cases. There is a modest trend towards unregulated centralization.
KeywordsRetroperitoneal lymph node dissection Testicular cancer Population-based analysis Centralization Health services research
German diagnosis-related groups
International classification of diseases
Laparoscopic retroperitoneal lymph node dissection
Non-seminomatous germ cell tumor
Operationen und Prozedurenschluessel = Classification of Operations and procedures
Open retroperitoneal lymph node dissection
Robot-assisted retroperitoneal lymph node dissection
Retroperitoneal lymph node dissection
Data source: German research data center of the federal statistical office, DRG statistics 2006–2015, German “National Centre for Cancer Registry Data” (Robert Koch Institute, Berlin), own calculations. We thank Melanie Scheller for supporting data retrieval. Part of this study was presented at the Annual Meetings of the European Association of Urology and the American Urological Association in 2018.
All Authors whose names appear on the submission have contributed sufficiently to the scientific work and, therefore, share collective responsibility and accountability for the results. CG: project development, data collection, data analysis, manuscript writing; RK: data analysis, statistics; TN, AB, and MB: project development, manuscript writing; KK: data collection, data analysis, manuscript editing; CT: manuscript editing; JH: project development, manuscript writing/editing.
Med-Drive Grant of the medical faculty Carl Gustav Carus TU Dresden. (Grant number: 60.356).
Compliance with ethical standards
Conflict of interest
Dr. Huber reports personal fees from Amgen and Janssen, grants and non-financial support from Intuitive Surgical and Takeda, outside the submitted work. All authors declare that there is no conflict of interest.
This study was conducted in accordance with the Declaration of Helsinki in its latest version. This article does not contain any studies with animals performed by any of the authors. Analyzed data were completely anonymized and derived from established databases with rigorous data protection measures. Hence, informed consent was not required.
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