The primary landing zone for metastatic testicular cancer is the lymph nodes of the retroperitoneum. Retroperitoneal lymph node dissection (RPLND) is the standard of care in several disease settings; for example, primary RPLND is indicated following orchiectomy and prior to (or instead of) systemic treatment, postchemotherapy RPLND (PC-RPLND) is indicated following identification of a residual mass after induction chemotherapy, and postsalvage chemotherapy RPLND is indicated after both induction and salvage chemotherapy. The overall complication rate ranges from 10%–25% for primary RPLND and 20%–30% for PC-RPLND and varies depending on the experience of the surgical center [1]. Common RPLND complications include pulmonary complications (particularly following bleomycin-containing chemotherapy regimens), ileus, lymphocele, chyle leak, ejaculatory dysfunction (with decreased risk associated with nerve-sparing RPLND), and deep vein thrombosis (DVT) with associated pulmonary embolism (PE) [2], [3], [4].

Deep vein thrombosis complications have been reported to occur in roughly 1% of primary RPLND cases and up to 3% of PC-RPLND cases [5,6]. Competing protective factors and risk factors are present in the typical patient population undergoing RPLND. Most patients undergoing RPLND are young and otherwise healthy and ambulatory; on the other hand, patients undergoing RPLND are predisposed to clot development due to a cancer diagnosis and (in the PC-RPLND setting) prior chemotherapy treatment, as patients receiving first-line bleomycin therapy have a DVT rate of 12.7% [7]. While prophylactic anticoagulation (AC) has been well-documented to reduce DVT rates in patients undergoing surgery in general, the benefit of prophylactic AC in RPLND has not been assessed [8]. Furthermore, while never thoroughly studied, there have been anecdotal reports that AC may contribute to chyle leak formation following RPLND, perhaps further limiting its study and use. In this retrospective cohort study, we seek to address this unmet need by evaluating the rates and associated risk factors of DVT and PE following RPLND with a national and institutional database, assess the changing patterns in DVT prophylaxis with postoperative AC following RPLND, and quantify the potential benefit of prophylactic AC in patients who have undergone RPLND using a risk-stratified approach.