Universität zu Köln

Groeben, Christer, Koch, Rainer, Nestler, Tim, Kraywinkel, Klaus, Borkowetz, Angelika, Wenzel, Stefanie, Baunacke, Martin, Thomas, Christian and Huber, Johannes ORCID: 0000-0001-7243-8958 (2020). Centralization tendencies of retroperitoneal lymph node dissection for testicular cancer in Germany? A total population-based analysis from 2006 to 2015. World J. Urol., 38 (7). S. 1765 - 1773. NEW YORK: SPRINGER. ISSN 1433-8726

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Abstract

Introduction 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). Results 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). Conclusion 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Groeben, Christer UNSPECIFIED UNSPECIFIED UNSPECIFIED Koch, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED Nestler, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Kraywinkel, Klaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Borkowetz, Angelika UNSPECIFIED UNSPECIFIED UNSPECIFIED Wenzel, Stefanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Baunacke, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Thomas, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Huber, Johannes UNSPECIFIED orcid.org/0000-0001-7243-8958 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-131032
DOI:	10.1007/s00345-019-02972-8
Journal or Publication Title:	World J. Urol.
Volume:	38
Number:	7
Page Range:	S. 1765 - 1773
Date:	2020
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1433-8726
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CELL TUMORS; RADICAL PROSTATECTOMY; TRENDS Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13103