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Brassetti A, Chiacchio G, Anceschi U, Bove A, Ferriero M, D'Annunzio S, Misuraca L, Guaglianone S, Tuderti G, Mastroianni R, Tedesco F, Cacciatore L, Proietti F, Flammia SR, De Nunzio C, Cozzi G, Leonardo C, Galosi AB, Simone G. Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review. Minerva Urol Nephrol 2024; 76:278-285. [PMID: 38920009 DOI: 10.23736/s2724-6051.24.05532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL). EVIDENCE ACQUISITION On April 9th, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("robotic assisted" OR "robot-assisted" OR "robotic") AND ("inguinal lymph node dissection" OR "lymphadenectomy") AND ("penile cancer" OR "vulvar cancer"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement. EVIDENCE SYNTHESIS Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients. CONCLUSIONS The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Chiacchio
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy -
| | - Umberto Anceschi
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Simone D'Annunzio
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Salvatore Guaglianone
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simone R Flammia
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
| | - Andrea B Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS - "Regina Elena" National Cancer Institute, Rome, Italy
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Falcone M, Gül M, Peretti F, Preto M, Cirigliano L, Scavone M, Sedigh O, Oderda M, Gontero P. Inguinal Lymphadenectomy for Penile Cancer: An Interim Report from a Trial Comparing Open Versus Videoendoscopic Surgery Using a Within-patient Design. EUR UROL SUPPL 2024; 63:31-37. [PMID: 38558767 PMCID: PMC10980994 DOI: 10.1016/j.euros.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Background and objective Nodal metastasis is a major survival and prognostic factor in penile cancer (PeCa). Thus, accurate staging, prognosis, and treatment selection require adequate inguinal lymphadenectomy (ILND). ILND surgery should balance oncologic rigor with morbidity and postoperative complications. Our aim was to compare the feasibility and safety of open ILND (OILND) and videoendoscopic ILND (VEILND) in patients with PeCa. Methods We conducted a single-center randomized trial with a within-patient design between October 2019 and April 2023. Patients who were undergoing either staging or radical ILND for PeCa were included and randomized to receive either OILND or VEILND on one side, with the other technique then used on the contralateral side. The trial was approved by the local ethics committee and was registered on ClinicalTrials.gov (NCT05887921). The primary outcome was the safety of VEILND. Secondary outcomes included intraoperative and postoperative morbidity rates and surgical outcomes for the two procedures, as well as oncological outcomes according to survival estimates. Key findings and limitations We included 14 patients in the study. Median follow-up was 12 mo (interquartile range [IQR] 12-17). There were no significant differences in operative time and the number of lymph nodes removed between OILND and VEILND. However, the median time to drain removal was significantly shorter in the VEILND group (15 d, IQR 13-17, 95% confidence interval [CI] 12-17) than in the OILND group (27 d, IQR 20-41, 95% CI 24-31; p = 0.025). No intraoperative complications were observed, but postoperative complications occurred in three cases (21.4%, 95% CI 8.4-37.8%) in the VEILND group and eight (57.1%, 95% CI 18.6-54.3%) in the OILND group (p = 0.032). Conclusions and clinical implications VEILND represents a safe technique to consider for either staging or curative intent in PeCa and seems to have an advantage over OILND in terms of morbidity. Further high-powered studies are warranted to confirm these preliminary results. Patient summary We compared the outcomes of two different surgical techniques to remove lymph nodes in patients with penile cancer. We found that a video-assisted keyhole surgery approach seems to result in a lower rate of complications than after open surgery.
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Affiliation(s)
- Marco Falcone
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
- Neurourology Clinic, Unità Spinale Unipolare, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Murat Gül
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Federica Peretti
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Mirko Preto
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Lorenzo Cirigliano
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Martina Scavone
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Omid Sedigh
- Urological Department, Gradenigo Hospital, Turin, Italy
| | - Marco Oderda
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Gontero
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
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Xu ZY, Li ZZ, Cao LM, Zhong NN, Liu XH, Wang GR, Xiao Y, Liu B, Bu LL. Seizing the fate of lymph nodes in immunotherapy: To preserve or not? Cancer Lett 2024; 588:216740. [PMID: 38423247 DOI: 10.1016/j.canlet.2024.216740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Lymph node dissection has been a long-standing diagnostic and therapeutic strategy for metastatic cancers. However, questions over myriad related complications and survival outcomes are continuously debated. Immunotherapy, particularly neoadjuvant immunotherapy, has revolutionized the conventional paradigm of cancer treatment, yet has benefited only a fraction of patients. Emerging evidence has unveiled the role of lymph nodes as pivotal responders to immunotherapy, whose absence may contribute to drastic impairment in treatment efficacy, again posing challenges over excessive lymph node dissection. Hence, centering around this theme, we concentrate on the mechanisms of immune activation in lymph nodes and provide an overview of minimally invasive lymph node metastasis diagnosis, current best practices for activating lymph nodes, and the prognostic outcomes of omitting lymph node dissection. In particular, we discuss the potential for future comprehensive cancer treatment with effective activation of immunotherapy driven by lymph node preservation and highlight the challenges ahead to achieve this goal.
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Affiliation(s)
- Zhen-Yu Xu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Xuan-Hao Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Guang-Rui Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Yao Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
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Sachdeva A, McGuinness L, Zapala Ł, Greco I, Garcia-Perdomo HA, Kailavasan M, Antunes-Lopes T, Ayres B, Barreto L, Campi R, Crook J, Johnstone P, Kumar V, Manzie K, Marcus JD, Necchi A, Oliveira P, Osborne J, Pagliaro LC, Protzel C, Bryan Rumble R, Sánchez Martínez DF, Spiess PE, Tagawa ST, van der Heijden MS, Parnham AS, Pettaway CA, Albersen M, Sangar VK, Brouwer OR, Sakalis VI. Management of Lymph Node-positive Penile Cancer: A Systematic Review. Eur Urol 2024; 85:257-273. [PMID: 37208237 DOI: 10.1016/j.eururo.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023]
Abstract
CONTEXT Lymph node (LN) involvement in penile cancer is associated with poor survival. Early diagnosis and management significantly impact survival, with multimodal treatment approaches often considered in advanced disease. OBJECTIVE To assess the clinical effectiveness of treatment options available for the management of inguinal and pelvic lymphadenopathy in men with penile cancer. EVIDENCE ACQUISITION EMBASE, MEDLINE, the Cochrane Database of Systematic Reviews, and other databases were searched from 1990 to July 2022. Randomised controlled trials (RCTs), nonrandomised comparative studies (NRCSs), and case series (CSs) were included. EVIDENCE SYNTHESIS We identified 107 studies, involving 9582 patients from two RCTs, 28 NRCSs, and 77 CSs. The quality of evidence is considered poor. Surgery is the mainstay of LN disease management, with early inguinal LN dissection (ILND) associated with better outcomes. Videoendoscopic ILND may offer comparable survival outcomes to open ILND with lower wound-related morbidity. Ipsilateral pelvic LN dissection (PLND) in N2-3 cases improves overall survival in comparison to no pelvic surgery. Neoadjuvant chemotherapy in N2-3 disease showed a pathological complete response rate of 13% and an objective response rate of 51%. Adjuvant radiotherapy may benefit pN2-3 but not pN1 disease. Adjuvant chemoradiotherapy may provide a small survival benefit in N3 disease. Adjuvant radiotherapy and chemotherapy improve outcomes after PLND for pelvic LN metastases. CONCLUSIONS Early LND improves survival in nodal disease in penile cancer. Multimodal treatments may provide additional benefit in pN2-3 cases; however, data are limited. Therefore, individualised management of patients with nodal disease should be discussed in a multidisciplinary team setting. PATIENT SUMMARY Spread of penile cancer to the lymph nodes is best managed with surgery, which improves survival and has curative potential. Supplementary treatment, including the use of chemotherapy and/or radiotherapy, may further improve survival in advanced disease. Patients with penile cancer with lymph node involvement should be treated by a multidisciplinary team.
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Affiliation(s)
- Ashwin Sachdeva
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.
| | - Luke McGuinness
- Department of Urology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Łukasz Zapala
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Isabella Greco
- Department of Urological Minimally Invasive and Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Herney Andres Garcia-Perdomo
- Division of Urology/Uro-oncology, Department of Surgery, School of Medicine, Universidad Del Valle, Cali, Colombia
| | | | | | - Benjamin Ayres
- Department of Urology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Lenka Barreto
- Department of Urology, University Hospital Nitra, Nitra, Slovakia
| | - Riccardo Campi
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy
| | - Juanita Crook
- British Columbia Cancer Agency, University of British Columbia, Kelowna, Canada
| | - Peter Johnstone
- Departments of Radiation Oncology and Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Vivek Kumar
- Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Andrea Necchi
- Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pedro Oliveira
- Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK; Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trásos-Montes and Alto Douro, Vila Real, Portugal; Veterinary Sciences Department, University of Trásos-Montes and Alto Douro, Vila Real, Portugal
| | | | | | | | - R Bryan Rumble
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott T Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA
| | | | - Arie S Parnham
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vijay K Sangar
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Oscar R Brouwer
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Ottenhof SR, de Vries HM, Doodeman B, Vrijenhoek GL, van der Noort V, Donswijk ML, de Feijter JM, Schaake EE, Horenblas S, Brouwer OR, van der Heijden MS, Pos FJ. A Prospective Study of Chemoradiotherapy as Primary Treatment in Patients With Locoregionally Advanced Penile Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:139-147. [PMID: 37030606 DOI: 10.1016/j.ijrobp.2023.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy followed by surgery for locoregionally advanced penile carcinoma (LAPSCC) is associated with severe toxicity and a 1-year survival probability of ∼50%. We aimed to evaluate the safety and efficacy of chemoradiotherapy (CRT) as the primary treatment for LAPSCC and the association of high-risk human papillomavirus (hrHPV) with the outcome. METHODS AND MATERIALS This was a prospective, single-center, single-arm study of CRT in LAPSCC, defined as a large/inoperable primary tumor, large palpable nodes, suspicion of extranodal extension or pelvic nodal involvement, and no distant metastases. CRT consisted of 49.5 Gy (33 × 1.5 Gy) on affected inguinal and pelvic areas combined with intravenous mitomycin C on day 1 and capecitabine on radiation days. Primary tumors and positron emission tomography/computed tomography-positive deposits received a boost of 59.4 Gy (33 × 1.8 Gy). The response was evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. If feasible, patients with residual/recurrent disease underwent salvage surgery. The primary endpoint was 1-year progression-free survival (PFS), reached when 1-year PFS was ≥50%. Other endpoints were 2-year PFS, overall survival, and toxicity rates. Kaplan-Meier survival curves were compared using the log-rank test. RESULTS Thirty-three patients were included: 29 (88%) with stage IV disease (T4 any-N M0 and/or any-T N3 M0) and 8 (24%) with hrHPV-positive disease. Median follow-up was 41 months. Thirty-two completed CRT. Eleven (33%) experienced ≥1 grade 3 treatment-related adverse event. There were no grade 4 or 5 treatment-related events. Twenty-four patients (73%) responded, including 13 (39%) complete responses. Nine patients (27%) underwent salvage surgery, and an additional 8 patients underwent later surgery (together 52%). One- and 2-year PFS were 34% and 31%, respectively. One- and 2-year overall survival were 73% and 46%, respectively. No significant difference between patients with hrHPV-positive and -negative tumors was observed. CONCLUSIONS CRT is a viable treatment option for LAPSCC with acceptable toxicity. CRT can result in an enduring response. If patients have residual tumor, salvage surgery is feasible. HrHPV status was not associated with outcomes.
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Affiliation(s)
| | | | - Barry Doodeman
- Departments of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Maarten Lucas Donswijk
- Departments of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Eva Eline Schaake
- Departments of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Departments of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Floris Jop Pos
- Departments of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Tobias-Machado M, Ornellas AA, Hidaka AK, Medina LG, Mattos PAL, Besio RS, Abreu D, Castro PR, Nishimoto RH, Astigueta J, Dourado A, Machado RD, Magnabosco WJ, Corona-Montes V, Villoldo GM, Zampolli HC, Taha A, Auad PR, Faria EF, Arantes PBO, Tavares A, Nascimento FSMS, Brazão ES, Rocha MM, Costa WH, Panico V, Reis LO, Almeida-Carrera RJ, Silva RC, Zequi SC, Calixto JRR, Sotelo R. Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer. Int Braz J Urol 2023; 49:580-589. [PMID: 37390124 PMCID: PMC10482462 DOI: 10.1590/s1677-5538.ibju.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
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Affiliation(s)
- Marcos Tobias-Machado
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | | | - Alexandre K Hidaka
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Luis G Medina
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pablo A L Mattos
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | - Juan Astigueta
- Universidad Privada Antenor Orrego, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo, Perú
| | - Aurus Dourado
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | | | - Anis Taha
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | - Pericles R Auad
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Walter H Costa
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Leonardo O Reis
- UroScience, Escola de Ciências Médicas, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de Campinas - PUC, Campinas, SP, Brasil
| | | | - Rafael C Silva
- Universidade Federal do Maranhão - UFMA, Maranhão, MA, Brasil
| | - Stênio C Zequi
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Rene Sotelo
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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7
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Gebruers J, Elst L, Baldewijns M, De Wever L, Van Laere K, Albersen M, Goffin K. Accuracy of dynamic sentinel lymph node biopsy for inguinal lymph node staging in cN0 penile cancer. EJNMMI Res 2023; 13:62. [PMID: 37351700 DOI: 10.1186/s13550-023-01013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Penile cancer is characterized by an early lymphatic dissemination. In intermediate and high-risk primary tumors without palpable inguinal lymph nodes, there is a 6-30% risk of micro-metastatic disease. Invasive lymph node staging in these patients is performed using dynamic sentinel lymph node biopsy (DSNB). In this study, the role of DSNB in cN0 penile cancer was studied, evaluating features of sentinel lymph node (SN) visualization and outcome parameters. Patients with penile cancer without inguinal lymph node metastases who were referred for DSNB at our center between January 2015 and May 2021 and had a follow-up period of at least 18 months, were retrospectively included. After injection of 85 ± 20 MBq [99mTc]Tc-nanocolloid peritumorally, dynamic, static planar and SPECT/CT imaging was performed. Primary endpoints were sensitivity of the diagnostic procedure, disease-free survival and DSNB-related adverse events. Secondary endpoints were SN detection rate, number of SNs and the number of counts of the most active SN. RESULTS Seventy-seven penile DSNB procedures in 75 patients (67 ± 11 years) were included. The detection rate of DSNB was 91% and 96% per procedure and groin, respectively. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were 79%, 100%, 97% and 100%, respectively. More SNs were seen on SPECT/CT than on static planar imaging (1.33 vs. 1.17, p = 0.001). The mean counts per SN on static planar imaging was lower compared to SPECT/CT (1343 vs. 5008; p < 0.0001). There was a positive correlation between the total counts of the SN on the static planar image and the SPECT/CT (r = 0.79, p < 0.0001). Only one out of seventy-five patients (1%) experienced DSNB-related adverse events. After 18 months, 58 patients remained disease free (77%), 13 developed local recurrence (17%), and 4 developed lymphatic or distant metastases (5%). CONCLUSION DNSB is a safe diagnostic procedure with a good detection rate and in particular high negative predictive value. It can therefore prevent overtreatment of patients with negative inguinal groins on clinical examination and DSNB examination. Finally, DSNB enables an early detection of occult metastases which would not be visualized with standardized imaging modalities.
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Affiliation(s)
- Juanito Gebruers
- Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Laura Elst
- Urology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Koen Van Laere
- Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | | | - Karolien Goffin
- Nuclear Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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8
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Glombik D, Davidsson S, Sandin F, Lambe M, Carlsson J, Sundqvist P, Kirrander P. Penile cancer: long-term infectious and thromboembolic complications following lymph node dissection - a population-based study (Sweden). Acta Oncol 2023:1-7. [PMID: 37130005 DOI: 10.1080/0284186x.2023.2206524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE To assess the long-term risks of infectious and thromboembolic events following inguinal (ILND) and pelvic (PLND) lymph node dissection in men with penile cancer. MATERIAL AND METHODS A total of 364 men subjected to ILND with or without PLND for penile cancer between 2000 and 2012 were identified in the Swedish National Penile Cancer Register. Each patient was matched based on age and county of residence with six penile cancer-free men. The Swedish Cancer Register and other population-based registers were used to retrieve information on treatment and hospitalisation for selected infectious and thromboembolic events. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazard models with multiple imputation. RESULTS The risk of infectious events remained increased for more than five years postoperatively in men with penile cancer compared with matched controls. The palpable nodal disease was the only predictor of these events, with risk increasing with the cN stage. The HR at one, three and five years and six months postoperatively was 8.60 (95% CI 5.16-14.34), 4.02 (95% CI 2.65-6.09) and 1.93 (95% CI 1.11-3.38), respectively. An increased risk of thromboembolic events persisted for three years postoperatively. The HR at one and three years postoperatively was 13.51 (95% CI 6.53-27.93) and 2.12 (95% CI 1.07-4.20). The results correspond well with the over-prescription of anticoagulants observed during this period. An association with bulky disease (cN3) was observed. CONCLUSIONS Lymph node dissection for penile cancer is associated with an increased risk of infectious and thromboembolic events. The findings of this population-based study show that the risks of these events remain increased more than five years for infectious and three years for thromboembolic events. Improved awareness of long-term complications following ILND is of importance both among patients and care givers to ensure early detection and treatment.
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Affiliation(s)
- Dominik Glombik
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sabina Davidsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Mats Lambe
- Regional Cancer Centre Central-Sweden, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jessica Carlsson
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Pernilla Sundqvist
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Peter Kirrander
- Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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9
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Schifano N, Fallara G, Rezvani S, Pozzi E, Churchill J, Castiglione F, Rewhorn M, Hadway P, Nigam R, Rees R, Sangar V, Lau M, Parnham A, Alnajjar H, Muneer A. Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique. World J Urol 2023:10.1007/s00345-023-04396-x. [PMID: 37019998 DOI: 10.1007/s00345-023-04396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE To describe our surgical technique and report the oncological outcomes and complication rates using a fascial-sparing radical inguinal lymphadenectomy (RILND) technique for penile cancer patients with cN+ disease in the inguinal lymph nodes. METHODS Over a 10-year period, 660 fascial-sparing RILND procedures were performed in 421 patients across two specialist penile cancer centres. The technique used a subinguinal incision with an ellipse of skin excised over any palpable nodes. Identification and preservation of the Scarpa's and Camper's fascia was the first step. All superficial inguinal nodes were removed en bloc under this fascial layer with preservation of the subcutaneous veins and fascia lata. The saphenous vein was spared where possible. Patient characteristics, oncologic outcomes and perioperative morbidity were retrospectively collected and analysed. Kaplan-Meier curves estimated the cancer-specific survival (CSS) functions after the procedure. RESULTS Median (interquartile range, IQR) follow-up was 28 (14-90) months. A median (IQR) number of 8.0 (6.5-10.5) nodes were removed per groin. A total of 153 postoperative complications (36.1%) occurred, including 50 conservatively managed wound infections (11.9%), 21 cases of deep wound dehiscence (5.0%), 104 cases of lymphoedema (24.7%), 3 cases of deep vein thrombosis (0.7%), 1 case of pulmonary embolism (0.2%), and 1 case of postoperative sepsis (0.2%). The 3-year CSS was 86% (95%Confidence Interval [95% CI] 77-96), 83% (95% CI 72-92), 58% (95% CI 51-66), respectively, for the pN1, pN2 and pN3 patients (p < 0.001), compared to a 3-year CSS of 87% (95% CI 84-95) for the pN0 patients. CONCLUSION Fascial-sparing RILND offers excellent oncological outcomes whilst decreasing the morbidity rates. Patients with more advanced nodal involvement had poorer survival rates, emphasizing the need for adjuvant chemo-radiotherapy.
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Affiliation(s)
- Nicolò Schifano
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Giuseppe Fallara
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
- Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sean Rezvani
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Edoardo Pozzi
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
- Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - James Churchill
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Fabio Castiglione
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Matthew Rewhorn
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Paul Hadway
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Raj Nigam
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Rowland Rees
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Vijay Sangar
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Maurice Lau
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Arie Parnham
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Hussain Alnajjar
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Asif Muneer
- Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK.
- NIHR Biomedical Research Centre University College London Hospital, London, UK.
- Division of Surgery and Interventional Science, University College London, London, UK.
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10
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Assessment and Reporting of Perioperative Adverse Events and Complications in Patients Undergoing Inguinal Lymphadenectomy for Melanoma, Vulvar Cancer, and Penile Cancer: A Systematic Review and Meta-analysis. World J Surg 2023; 47:962-974. [PMID: 36709215 DOI: 10.1007/s00268-022-06882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) plays a crucial role in the oncological management of patients with melanoma, penile, and vulvar cancer. This study aims to systematically evaluate perioperative adverse events (AEs) in patients undergoing ILND and its reporting. METHODS A systematic review was conducted according to PRISMA. PubMed, MEDLINE, Scopus, and Embase were queried to identify studies discussing perioperative AEs in patients with melanoma, penile, and vulvar cancer following ILND. RESULTS Our search generated 3.469 publications, with 296 studies meeting the inclusion criteria. Details of 14.421 patients were analyzed. Of these studies, 58 (19.5%) described intraoperative AEs (iAEs) as an outcome of interest. Overall, 68 (2.9%) patients reported at least one iAE. Postoperative AEs were reported in 278 studies, combining data on 10.898 patients. Overall, 5.748 (52.7%) patients documented ≥1 postoperative AEs. The most reported ILND-related AEs were lymphatic AEs, with a total of 4.055 (38.8%) events. The pooled meta-analysis confirmed that high BMI (RR 1.09; p = 0.006), ≥1 comorbidities (RR 1.79; p = 0.01), and diabetes (RR 1.81; p = < 0.00001) are independent predictors for any AEs after ILND. When assessing the quality of the AEs reporting, we found 25% of studies reported at least 50% of the required criteria. CONCLUSION ILND performed in melanoma, penile, and vulvar cancer patients is a morbid procedure. The quality of the AEs reporting is suboptimal. A more standardized AEs reporting system is needed to produce comparable data across studies for furthering the development of strategies to decrease AEs.
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11
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European Association of Urology-American Society of Clinical Oncology Collaborative Guideline on Penile Cancer: 2023 Update. Eur Urol 2023; 83:548-560. [PMID: 36906413 DOI: 10.1016/j.eururo.2023.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Penile cancer is a rare disease but has a significant impact on quality of life. Its incidence is increasing, so it is important to include new and relevant evidence in clinical practice guidelines. OBJECTIVE To provide a collaborative guideline that offers worldwide physician and patient guidance for the management of penile cancer. EVIDENCE ACQUISITION Comprehensive literature searches were performed for each section topic. In addition, three systematic reviews were conducted. Levels of evidence were assessed, and a strength rating for each recommendation was assigned according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. EVIDENCE SYNTHESIS Penile cancer is a rare disease but its global incidence is increasing. Human papillomavirus (HPV) is the main risk factor for penile cancer and pathology should include an assessment of HPV status. The main aim of primary tumour treatment is complete tumour eradication, which has to be balanced against optimal organ preservation without compromising oncological control. Early detection and treatment of lymph node (LN) metastasis is the main determinant of survival. Surgical LN staging with sentinel node biopsy is recommended for patients with a high-risk (≥pT1b) tumour with cN0 status. While (inguinal) LN dissection remains the standard for node-positive disease, multimodal treatment is needed in patients with advanced disease. Owing to a lack of controlled trials and large series, the levels of evidence and grades of recommendation are low in comparison to those for more common diseases. CONCLUSIONS This collaborative penile cancer guideline provides updated information on the diagnosis and treatment of penile cancer for use in clinical practice. Organ-preserving surgery should be offered for treatment of the primary tumour when feasible. Adequate and timely LN management remains a challenge, especially in advanced disease stages. Referral to centres of expertise is recommended. PATIENT SUMMARY Penile cancer is a rare disease that significantly impacts quality of life. While the disease can be cured in most cases without lymph node involvement, management of advanced disease remains challenging. Many unmet needs and unanswered questions remain, underlining the importance of research collaborations and centralisation of penile cancer services.
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12
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Brassetti A, Anceschi U, Cozzi G, Chavarriaga J, Gavrilov P, Gaya Sopena JM, Bove AM, Prata F, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Camacho D, Musi G, Varela R, Breda A, De Cobelli O, Simone G. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr Oncol 2023; 30:1882-1892. [PMID: 36826107 PMCID: PMC9954864 DOI: 10.3390/curroncol30020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. METHODS A purpose-built multicenter, multi-national database was queried for stage I-IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan-Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. RESULTS A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11-27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan-Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94-0.99; p = 0.04). CONCLUSIONS Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652666772
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Cozzi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Julian Chavarriaga
- Division of Urology, Clinica Imbanaco, Quiron Salud, Cali 760042, Colombia
- Division of Urology, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Pavel Gavrilov
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | | | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Diego Camacho
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Rodolfo Varela
- Division of Urologic Oncology Instituto Nacional de Cancerologia, Bogota 111511, Colombia
| | - Alberto Breda
- Department of Urology, Fondacio Puigvert, 08025 Barcelona, Spain
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, 20141 Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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13
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Morbidity and risk factors for complications of inguinal lymph node dissection in penile cancer. World J Urol 2023; 41:109-118. [PMID: 36208315 DOI: 10.1007/s00345-022-04169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/23/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To assess the morbidity of inguinal lymph node dissection (ILND) in penile cancer, then to compare this morbidity with that of ILND performed in the context of skin cancer treatment. METHODS We retrospectively included all patients having undergone ILND between 1 January 2004 and 31 December 2019 in our centre's urology department in the context of treatment of penile cancer or skin cancer. Postoperative complications were reported in accordance with the Clavien-Dindo classification system. RESULTS Two hundred forty-two ILNDs were performed in 122 patients with penile cancer and 56 ILNDs were performed in 56 patients with skin cancer. The most common early complication was postoperative fluid collection (lymphocele or haematoma), which complicated 44% of ILNDs overall and 60% of radical lymphadenectomies. The most common late complication was leg lymphoedema, found in up to 36% of radical lymphadenectomies. Major complications (grade ≥ III) were very rare (4% of radical lymphadenectomies). Radical lymphadenectomies resulted in significantly more cases of postoperative fluid collection, skin necrosis and dehiscence, as well as leg lymphoedema, than modified lymphadenectomy techniques. Two factors significantly increasing postoperative morbidity were demonstrated: ASA score = 3 (OR = 3.09) and operating time (OR = 1.01). CONCLUSION ILNDs are morbid surgical procedures for which the indications must be well defined. However, the complications are almost exclusively minor, for a major oncological benefit.
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14
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Chua KJ, Balraj V, Patel HV, Srivastava A, Doppalapudi SK, Elsamra SE, Jang TL, Singer EA, Ghodoussipour SB. Wound Complication Rates after Inguinal Lymph Node Dissection: Contemporary Analysis of the NSQIP Database. J Am Coll Surg 2023; 236:18-25. [PMID: 36519902 PMCID: PMC9764259 DOI: 10.1097/xcs.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) is used for diagnosis and treatment in penile cancer (PC), vulvar cancer (VC), and melanomas draining to the inguinal lymph nodes. However, ILND is often characterized by its morbidity and high wound complication rate. Consequently, we aimed to characterize wound complication rates after ILND. STUDY DESIGN The NSQIP database was queried for ILND performed from 2005 to 2018 for melanoma, PC, or VC. Thirty-day wound complications included wound disruption and superficial, deep, and organ-space surgical site infection. Multivariable logistic regression was performed with covariates, including cancer type, age, American Society of Anesthesiologists score ≥3, BMI ≥30, smoking history, diabetes, operative time, and concomitant pelvic lymph node dissection. RESULTS A total of 1,099 patients had an ILND with 92, 115, and 892 ILNDs performed for PC, VC, and melanoma, respectively. Wound complications occurred in 161 (14.6%) patients, including 12 (13.0%), 17(14.8%), and 132 (14.8%) patients with PC, VC, and melanoma, respectively. Median length of stay was 1 day (interquartile range 0 to 3 days), and median operative time was 152 minutes (interquartile 83 to 192 minutes). Readmission rate was 12.7%. Wound complications were associated with longer operative time per 10 minutes (odds ratio 1.038, 95% CI 1.019 to 1.056, p < 0.001), BMI ≥30 (odds ratio 1.976, 95% CI 1.386 to 2.818, p < 0.001), and concomitant pelvic lymph node dissection (odds ratio 1.561, 95% CI 1.056 to 2.306, p = 0.025). CONCLUSIONS Predictors of wound complications after ILND include BMI ≥30, longer operative time, and concomitant pelvic lymph node dissection. There have been efforts to decrease ILND complication rates, including minimally invasive techniques and modified templates, which are not captured by NSQIP, and such approaches may be considered especially for those with increased complication risks.
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Affiliation(s)
- Kevin J Chua
- From the Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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15
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Fallara G, Pozzi E, Onur Cakir O, Tandogdu Z, Castiglione F, Salonia A, Alnajjar HM, Muneer A. Diagnostic Accuracy of Dynamic Sentinel Lymph Node Biopsy for Penile Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2022:S2405-4569(22)00277-2. [DOI: 10.1016/j.euf.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
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16
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Savoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, Camparo P, Fléchon A, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines - Update 2022-2024: penile cancer. Prog Urol 2022; 32:1010-1039. [PMID: 36400476 DOI: 10.1016/j.purol.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update French oncology guidelines concerning penile cancer. METHODS Comprehensive Medline search between 2020 and 2022 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organsparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital Européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, Boulevard Sainte Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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17
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Agostini E, Castellani D, Gatta E, Galosi AB. Femoral artery blowout syndrome after inguinal lymphadenectomy for penile cancer. Asian J Urol 2022. [PMID: 37538151 PMCID: PMC10394298 DOI: 10.1016/j.ajur.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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18
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Das MK, Pandey A, Mandal S, Nayak P, Kumaraswamy S. Modified Video Endoscopic Inguinal Lymphadenectomy: a deep-first approach. Urology 2022; 168:234-239. [PMID: 35718135 DOI: 10.1016/j.urology.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe our modified technique of performing video endoscopic inguinal lymphadenectomy (VEIL) with the proposed benefits of a shallow learning curve and better ergonomics. METHODS We describe our modified VEIL technique: the deep first approach, in a squamous cell carcinoma penis patient with a pathological T3 disease and bilateral palpable, mobile inguinal lymph nodes post penectomy. RESULTS The surface markings and the port incision sites for the procedure were conventional. However, in contrast to the standard superficial dissection plane development below the Scarpa's fascia at the initial camera port site, our technique commenced with a deep dissection plane just above the fascia lata. The dissection limits were directly identified: the sartorius muscle laterally, the inguinal ligament superiorly, and the adductor longus muscle medially. The saphenous vein was identified early and close to the saphenofemoral junction, allowing undemanding dissection. The superficial flap dissection was done entirely under direct vision, with better ergonomics owing to a continuous counter-traction by the pressure of insufflated gas. Deep inguinal nodal dissection then concluded the procedure. CONCLUSIONS The described technique is surmised to be easier to perform, given the lack of ambiguity in the correct initial dissection plane, direct visualization of surgical landmarks early in the procedure, and early identification of the saphenous vein close to the SFJ. It may improve the learning curve allowing for a wider acceptance of VEIL.
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Affiliation(s)
- Manoj K Das
- MCh Urology, Assistant Professor, Department of Urology, AIIMS, Bhubaneswar, India.
| | - Abhishek Pandey
- MS General Surgery, Senior Resident (Academic), Department of Urology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | - Swarnendu Mandal
- MCh Urology, Assistant Professor, Department of Urology, AIIMS, Bhubaneswar, India.
| | - Prasant Nayak
- MCh Urology, Additional Professor and Head of department of Urology, AIIMS, Bhubaneswar, India.
| | - Santosh Kumaraswamy
- MS General Surgery, Senior Resident (Academic), Department of Urology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
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19
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Sood A, Rudzinski JK, Spiess PE, Pettaway CA. The Acute Complications After Surgery for Penile Carcinoma and Strategies for Their Management: A Systematic Review of the Literature. Semin Oncol Nurs 2022; 38:151285. [PMID: 35597731 DOI: 10.1016/j.soncn.2022.151285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the contemporary rates of 30-day complications after surgery for penile cancer and to discuss the currently used preventative and therapeutic practices aimed at mitigation of these postoperative adverse events. DATA SOURCES A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed, and studies reporting on the contemporary rates, nature, or management of acute complications following primary penile surgery or inguinal lymph node dissection for penile cancer were abstracted. Medline (PubMed) and EMBASE libraries were used to retrieve the articles published between January 1984 and December 2021 (n = 170 articles). Ultimately, 38 articles were included. The primary outcome of interest was 30-day (acute) postoperative complications, stratified by those associated with treatment of the primary penile lesion and those with inguinal lymph node dissection. Risk of bias assessment was undertaken. Special attention was paid to studies reporting management strategies for these complications. CONCLUSION This comprehensive review revealed that the quality of existing studies reporting on complications is poor and the risk of bias is high. Within these studies, the rates of acute complications following primary penile surgery and inguinal lymph node dissection ranged between 0% and 29.4% and 6% and 90%, respectively. More than 50% of these complications were wound related. Over the past two decades, several studies have reported on improved surgical techniques and protocolized postsurgical care pathways. Although the newer techniques have been associated with improved outcomes, the absolute rates of complications have remained high even in the most contemporary series. Therefore, there is an urgent need for health care providers and stakeholders to reach consensus regarding preoperative workup and medical optimization goals, stage appropriate therapies, and postoperative care pathways, as has been done for other malignancies associated with high morbidity. IMPLICATIONS FOR NURSING PRACTICE Penile cancer is a disease of the elderly, and surgical management of the primary lesion or the groins is associated with a high rate of complications. Most complications are wound related. Meticulous surgical technique and careful postoperative monitoring with early intervention are keys to mitigating surgery-related morbidity. However, equally important is dissemination and adoption of these principles by all health care workers universally.
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Affiliation(s)
- Akshay Sood
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jan K Rudzinski
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Curtis A Pettaway
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX.
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20
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Nemitz L, Vincke A, Michalik B, Engels S, Meyer LM, Henke RP, Wawroschek F, Winter A. Radioisotope-Guided Sentinel Lymph Node Biopsy in Penile Cancer: A Long-Term Follow-Up Study. Front Oncol 2022; 12:850905. [PMID: 35494039 PMCID: PMC9046689 DOI: 10.3389/fonc.2022.850905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Lymph node (LN) management is critical for survival in patients with penile cancer. However, radical inguinal lymphadenectomy carries a high risk of postoperative complications such as lymphedema, lymphocele, wound infection, and skin necrosis. The European Association of Urology guidelines therefore recommend invasive LN staging by modified inguinal lymphadenectomy or dynamic sentinel node biopsy (DSNB) in clinically node-negative patients (cN0) with intermediate- and high-risk tumors (≥ T1G2). However, the timing of DSNB (simultaneous vs. subsequent to partial or total penile resection) is controversial and the low incidence of penile cancer means that data on the long-term outcomes of DSNB are limited. The present study aimed to analyze the reliability and morbidity of DSNB in patients with penile cancer during long-term follow-up. This retrospective study included 41 patients (76 groins) who underwent radioisotope-guided DSNB simultaneously or secondarily after penile surgery from June 2004 to November 2018. In total, 193 sentinel LNs (SLNs) and 39 non-SLNs were removed. The median number of dissected LNs was 2.5 (interquartile range 2–4). Histopathological analysis showed that five of the 76 groins (6.6%) contained metastases. None of the non-SLNs were tumor-positive. In accordance with the guidelines, all inguinal regions with positive SLNs underwent secondary radical inguinal lymphadenectomy, which revealed three additional metastases in one groin. Regional LN recurrence was detected in three patients (four groins) during a median follow-up of 70 months, including two patients in whom DSNB had been performed secondarily after repetitive penile tumor resections. DSNB-related complications occurred in 15.8% of groins. Most complications were mild (Clavien–Dindo grade I; 50%) or moderate (II; 25%), and invasive intervention was only required in 3.9% of groins (IIIa: n = 1; IIIb: n = 2). In summary, this study suggests that the current radioisotope-guided DSNB procedure may reduce the complication rate of inguinal lymphadenectomy in patients with cN0 penile cancer. However, DSNB and penile surgery should be performed simultaneously to minimize the false-negative rate. Recent advances, such as new tracers and imaging techniques, may help to reduce the false-negative rate of DSNB further.
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Affiliation(s)
- Lena Nemitz
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Anna Vincke
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Bianca Michalik
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Svenja Engels
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Luca-Marie Meyer
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- *Correspondence: Alexander Winter,
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21
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Genes WP, Fierro MC, Guerrero AE, Lozano AMM, Rozo YCT, Sánchez AFP. Guia de cáncer de pene de la Sociedad Colombiana de Urología. Rev Urol 2022. [DOI: 10.1055/s-0041-1740533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ResumenEl cáncer de pene tiene una incidencia de 1.11 por 100.000 habitantes en Colombia, representado en el 95% por carcinoma de células escamosas el cual representa una alta morbilidad y mortalidad, La Sociedad Colombiana de Urología realizo la adaptación de la guía de cáncer de pene para el año 2021 con revisión de la literatura, esta guía permite realizar una evaluación y tratamiento del cáncer de pene, en muchas ocasiones con el objetivo de preservación de órgano utilizando la ecografía como determinante para evaluar el compromiso de la lesión a las estructuras del pene, los estudios de extensión dependerán de hallazgos al examen físico como ganglios o compromiso local de la enfermedad, de acuerdo al tipo de lesión y su estadificación puede recibir terapia con agentes tópicos, radioterapia, cirugía láser, cirugía preservadora de órgano o penectomía total; La linfadenectomía inguinal permitirá mejorar la supervivencia en tumores de riesgo intermedio y alto (>pT1G2), posteriormente la quimioterapia adyuvante esta en el grupo de pacientes en el cual la intención sea curativa, aunque en terapia paliativa de segunda línea se encuentran los platinos y texanos como alternativa pero con pobre respuesta (<30%); los esquemas de seguimiento se realiza de acuerdo al estadio y el compromiso ganglionar. Al final se presentan los resultados de actividad sexual después de cirugía preservadora de órgano; Esta guía abarca la literatura actualizada del cáncer de pene, el cual es útil para el manejo por parte de los profesionales de salud del país.
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Affiliation(s)
- William Pertuz Genes
- Department of Oncological Urology, Universidad de Cartagena, Cartagena de Indias, Colombia
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22
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Wever L, de Vries HM, Dell'Oglio P, van der Poel HG, Donswijk ML, Sikorska K, van Leeuwen FWB, Horenblas S, Brouwer OR. Incidence and risk factor analysis of complications after sentinel node biopsy for penile cancer. BJU Int 2022; 130:486-495. [PMID: 35257463 DOI: 10.1111/bju.15725] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical staging is recommended in intermediate to high risk clinically node negative (cN0) penile cancer (PeCa). Because (modified) inguinal lymph node dissection (ILND) is associated with high morbidity, dynamic sentinel node biopsy (DSNB) was introduced with the aim to reduce morbidity while maintaining diagnostic accuracy. OBJECTIVE To determine the incidence and types of complications after DSNB and identify risk factors for the occurrence of postoperative complications. PATIENTS AND METHODS We evaluated 644 PeCa patients (1284 DSNB procedures) with at least one cN0 groin who underwent DSNB between 2011 and 2020 at a single high-volume centre. 30-day and 30-90-day postoperative complications were collected according to the modified Clavien Dindo classification and the standardized methodology proposed by the European Association of Urology panel. Univariable and multivariable generalized linear mixed models were used to identify risk factors for the occurrence of complications per groin. RESULTS A 30-day postoperative complication occurred in 14% of groins (n=186), of which 94% were mild to moderate. Wound infection and lymphocele formation were most common. 30-90-day postoperative complications occurred in 3.4% of the groins, all of which were mild or moderate (grade 1-2). The number of removed LNs per groin was the main independent predictor for any 30-day complications and grade≥2 complications (OR 1.40; p<0.001). An increase in the probability of postoperative complications with the number of LNs removed was observed after accounting for all confounders. CONCLUSIONS Despite being less morbid than (modified) ILND, DSNB is still associated with a considerable risk of mild to moderate postoperative complications. This risk increases with an increasing number of LNs removed. Further procedural refinement aimed at removing the true sentinel node(s) only, may help further reduce the morbidity of surgical staging in PeCa.
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Affiliation(s)
- Lieke Wever
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Hielke M de Vries
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Paolo Dell'Oglio
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Karolina Sikorska
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Simon Horenblas
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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23
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Ma S, Zhang K, Li R, Lu J, Wu T, Liu Z, Fu X, Tang Q, Ma J. Bilateral inguinal lymphadenectomy using simultaneous double laparoscopies for penile cancer: A retrospective study. Urol Oncol 2022; 40:112.e1-112.e9. [DOI: 10.1016/j.urolonc.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/02/2021] [Accepted: 12/31/2021] [Indexed: 01/23/2023]
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24
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Lee EWC, Issa A, Oliveira P, Lau M, Sangar V, Parnham A, Fankhauser CD. High diagnostic accuracy of inguinal ultrasonography and fine needle aspiration followed by dynamic sentinel lymph node biopsy in men with non‐palpable and palpable inguinal lymph nodes. BJU Int 2022; 130:331-336. [DOI: 10.1111/bju.15700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Maurice Lau
- The Christie NHS Foundation Trusts Manchester UK
| | - Vijay Sangar
- The Christie NHS Foundation Trusts Manchester UK
| | - Arie Parnham
- The Christie NHS Foundation Trusts Manchester UK
| | - Christian D. Fankhauser
- The Christie NHS Foundation Trusts Manchester UK
- Luzerner Kantonsspital, Luzern Switzerland
- University of Zurich Zurich Switzerland
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25
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de Vries H, Lee H, Lam W, Djajadiningrat R, Ottenhof S, Roussel E, Kroon B, de Jong I, Oliveira P, Alnajjar H, Albersen M, Muneer A, Sangar V, Parnham A, Ayres B, Watkin N, Horenblas S, Stuiver M, Brouwer O. Clinicopathologic predictors of finding additional inguinal lymph node metastases in penile cancer patients following positive dynamic sentinel node biopsy: a European multicentre evaluation. BJU Int 2021; 130:126-132. [DOI: 10.1111/bju.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/24/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- H.M. de Vries
- Department of Urology Netherlands Cancer Institute Amsterdam Netherlands
| | - H.J. Lee
- Department of Urology St. George University Hospital NHS foundation trust London United Kingdom
| | - W. Lam
- Department of Urology St. George University Hospital NHS foundation trust London United Kingdom
| | | | - S.R. Ottenhof
- Department of Urology Netherlands Cancer Institute Amsterdam Netherlands
| | - E. Roussel
- Department of Urology University Hospital Leuven Leuven Belgium
| | - B.K. Kroon
- Department of Urology Rijnstate Hospital Arnhem Netherlands
| | - I.J. de Jong
- Department of Urology University Medical Centre Groningen Groningen Netherlands
| | - P. Oliveira
- Department of Pathology The Christie NHS foundation trust Manchester United Kingdom
| | - H.M. Alnajjar
- Department of Urology and NIHR Biomedical Research Centre University College London Hospitals NHS foundation trust London United Kingdom
| | - M. Albersen
- Department of Urology University Hospital Leuven Leuven Belgium
| | - A. Muneer
- Department of Urology and NIHR Biomedical Research Centre University College London Hospitals NHS foundation trust London United Kingdom
- Division of Surgery and Interventional Science University College London Hospitals NHS foundation trust London United Kingdom
| | - V. Sangar
- Department of Urology The Christie NHS foundation trust London United Kingdom
- Manchester Academic Health Sciences Centre University of Manchester United Kingdom
| | - A. Parnham
- Department of Urology The Christie NHS foundation trust London United Kingdom
| | - B. Ayres
- Department of Urology St. George University Hospital NHS foundation trust London United Kingdom
| | - N. Watkin
- Department of Urology St. George University Hospital NHS foundation trust London United Kingdom
| | - S. Horenblas
- Department of Urology Netherlands Cancer Institute Amsterdam Netherlands
| | - M.M. Stuiver
- Department of Clinical Epidemiology Amsterdam University Medical Centres location AMC Amsterdam Netherlands
| | - O.R. Brouwer
- Department of Urology Netherlands Cancer Institute Amsterdam Netherlands
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26
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Jakobsen JK. Sentinel Node Methods in Penile Cancer - a Historical Perspective on Development of Modern Concepts. Semin Nucl Med 2021; 52:486-497. [PMID: 34933740 DOI: 10.1053/j.semnuclmed.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 02/06/2023]
Abstract
Malignant penile tumors are of squamous cell origin in more than 95% of cases and the occurrence of a distant metastasis without prior inguinal lymph node metastatic deposits is very rare. This makes inguinal lymph node staging very reliable and of great prognostic significance since undiscovered and untreated inguinal metastases may lead to a fatal clinical course. In lack of a sufficiently accurate noninvasive lymph node staging modality, penile cancer relies on surgical lymph node removal for regional staging. In this respect sentinel node biopsy offers a favourable minimally invasive alternative to prophylactic inguinal lymph node dissection which is associated with significant surgery-related morbidity. Today sentinel node biopsy is widely used in surgical oncology within high volume cancers such as breast cancer and melanoma. In rare cancers sentinel node biopsy is also emerging as a minimal invasive staging tool in patients with no obvious lymph node involvement. At several specialized units across Europe sentinel node biopsy has been practiced by dedicated specialist within vulva and penile cancer for more than two decades. In fact, the rare disease penile cancer was a model entity for development of the original sentinel node concept as early as the 1970'es due to work by the Paraguayan penile cancer pioneer, Cabañas, the sentinel node concept was subsequently successfully adapted in breast cancer and melanoma. This turned out mutually beneficial since the sequential development of sentinel node biopsy in penile cancer in the 1990s eventually adopted new insights and added conceptual details from the experiences harvested in the broader clinical application possible in these high-volume diseases. The prerequisite to conceptualising the sentinel node approach was the gradual anatomical and functional understanding of the lymphatic system which in western medicine rooted in ancient Greece and gradually increased in details and comprehension with significant contributions from many great notabilities during the last centuries including Hippocrates, Galen, Fallopio, Malpighi, Virchow, Starling, Cabañas, Hodgkin and Horenblas. Sentinel node biopsy in penile cancer is a complex multimodality procedure involving inguinal ultrasonography by radiologists, precise tracer-injection and interpretation of nuclear images by nuclear medicine physicians, radio-tracer- and dye guided open surgical biopsies by urologists and thorough step-sectioning, immunostaining and accurate lymph node specimen analysis by pathologists. This team effort requires well-tested protocols, experience and good collaboration and in rare diseases this calls for centralization of service.
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27
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Li H, Ma Y, Jian Z, Jin X, Xiang L, Li H, Wang K. Lymph Node Dissections for T3T4 Stage Penile Cancer Patients Without Preoperatively Detectable Lymph Node Metastasis Bring More Survival Benefits: A Propensity Matching Analysis. Front Oncol 2021; 11:712553. [PMID: 34631537 PMCID: PMC8497980 DOI: 10.3389/fonc.2021.712553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Aims The current guidelines for the treatment of penile cancer patients with clinically non-invasive normal inguinal lymph nodes are still broad, so the purpose of this study is to determine which patients are suitable for lymph node dissection (LND). Methods Histologically confirmed penile cancer patients (primary site labeled as C60.9-Penis) from 2004 to 2016 in the Surveillance, Epidemiology, and Results database were included in this analysis. Univariate and multivariate Cox regression analyses were applied to determine an overall estimate of LND on overall survival and cancer-specific survival. A 1:1 propensity matching analysis (PSM) was applied to enroll balanced baseline cohort, and further Kaplan-Meier (KM) survival analysis was used to get more reliable results. Results Out of 4,458 histologically confirmed penile cancer patients with complete follow-up information, 1,052 patients were finally enrolled in this analysis. Age, pathological grade, T stage, and LND were identified as significant predictors for overall survival (OS) in the univariate Cox analysis. In the multivariate Cox regression, age, pathological grade, T stage, and LND were found significant. The same results were also found in the univariate and multivariate Cox regression analyses for cancer-specific survival (CSS). After the successful PSM, further KM analysis revealed that LND could bring significant OS and CSS benefits for T3T4 patients without lymph node metastasis. Conclusion Lymph node dissection may bring survival benefits for penile cancer patients without preoperatively detectable lymph node metastasis, especially for T3T4 stage patients. Further randomized control trial is needed.
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Affiliation(s)
- Han Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, Chengdu No. 5 People's Hospital, Chengdu, China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Liyuan Xiang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China
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28
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Savoie PH, Morel-Journel N, Murez T, Ferretti L, Rocher L, Fléchon A, Camparo P, Méjean A. [French ccAFU guidelines - update 2020-2022: penile cancer]. Prog Urol 2021; 30:S252-S279. [PMID: 33349426 DOI: 10.1016/s1166-7087(20)30753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE - To update French oncology guidelines concerning penile cancer. METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS - Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organ-sparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS - Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P-H Savoie
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, Cedex 09, France.
| | - N Morel-Journel
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, Cedex 5, France
| | - L Ferretti
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Méjean
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Murugesan A. Cost-effective, Clean, Absorbent Dressings for Wounds with Copious Lymphorrhoea. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jakobsen JK, Høyer S, Bouchelouche K, Jensen JB. DaPeCa-8: drawing the map of lymphatic drainage in patients with invasive penile cancer - evidence from SPECT/CT and sentinel node surgery. Scand J Urol 2021; 55:383-387. [PMID: 33569972 DOI: 10.1080/21681805.2021.1882560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anatomy of the lymphatic drainage guides the extent of inguinal lymph node dissection in penile cancer. OBJECTIVE To prospectively assess the lymphatic drainage of penile cancer with single-photon emission computed tomography CT (SPECT-CT) and implications for the extent of inguinal lymph node dissection. METHODS We assessed the lymphatic drainage of 62 patients with at least unilateral clinical lymph node-negative (cN0) status with SPECT-CT at our tertiary referral centre. We evaluated 122 cN0 inguinal basins and compared them to the histopathological outcome. The inguinal regions were divided into ten different Daseler zones on SPECT-CT. The surgical team filled in a corresponding scheme at sentinel node biopsy and sent lymph nodes from each Daseler zone individually for histopathological examination. RESULTS SPECT-CT successfully visualized lymphatic drainage in 116 of the 122 cN0 inguinal basins (95.1%). The vast majority of sentinel nodes and all metastatic nodes were located in central and superior inguinal zones, including six metastatic nodes in lateral superior zones. Minimal lymphatic drainage was seen to the inferior Daseler zones and no metastatic deposits were located here. No direct pelvic drainage was observed. CONCLUSIONS Penile cancer lymphatic drainage is primarily to sentinel in the superior and central zones of Daseler. Colleagues practicing a modified inguinal lymph node dissection as a standard in cN0 patients are encouraged to include all these zones, while the inferior zones can be omitted. This study confirms the absence of lymphatic drainage directly to the pelvic region and supports the practice of omitting pelvic nodes from sentinel node biopsy.
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Affiliation(s)
| | - Søren Høyer
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Thyavihally YB, Dev P, Waigankar SS, Pednekar A, Kulkarni B, Sharma A, Maheshwari S, Roy D, Agarwal V, Khandekar AA, Badlani ND, Asari AN, Sanwalka N. Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis. J Robot Surg 2021; 15:905-914. [PMID: 33484414 DOI: 10.1007/s11701-020-01189-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022]
Abstract
Open inguinal lymph node dissection (O-ILND) is the gold standard in the management of lymph nodes in carcinoma penis; however, video endoscopic inguinal lymphadenectomy (VEIL) is performed in some centers. Our primary objective is to compare perioperative and survival outcomes in patients undergoing VEIL with O-ILND, as very few studies have reported long-term survival outcomes till date. We analyzed patients who underwent O-ILND and VEIL (laparoscopic or robot-assisted) from January 2009 to January 2020 in our institute for carcinoma of the penis. Patient details, perioperative complications, and survival outcomes were analyzed. Perioperative outcomes were analyzed by logistic regression and survival outcomes by log-rank and Cox regression methods. We analyzed 79 patients (32 O-ILND, 47 VEIL) with a median follow-up of 51 (IQR 25.5-75.5) and 42 months (IQR 21-62). Wound complications were common in O-ILND group (65.6%) compared to VEIL group (27.7%) (p = 0.001), predominantly skin flap necrosis in 14 groins (23.73%) after O-ILND and none after VEIL. Median overall survival was 80 and 88 months (p = 0.840) with five-year survival of 65% and 66.8% (p = 0.636) and five-year DSS of 76.6% and 73.9% (p = 0.96) in O-ILND and VEIL, respectively. Multivariate analysis showed that grade and pathological node status were significant (HR-2.650, p = 0.040; HR-3.218, p = 0.024) factors for survival. The retrospective nature of the study design is the limitation. Management of inguinal lymph nodes in carcinoma penis by VEIL is safe, associated with lesser wound-related complications, and equivalent survival outcomes compared to O-ILND. It should be considered as an alternative option for inguinal lymph node dissection.
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Affiliation(s)
- Yuvaraja B Thyavihally
- Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053.
| | - Preetham Dev
- Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Santosh S Waigankar
- Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Abhinav Pednekar
- Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Bijal Kulkarni
- Pathology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Anshu Sharma
- Nuclear Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Sharad Maheshwari
- Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Diptiman Roy
- Interventional Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Varun Agarwal
- Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Archan A Khandekar
- Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Naresh D Badlani
- Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Ashish N Asari
- Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
| | - Neha Sanwalka
- Clinical Statistics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053
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Practice Patterns Among Penile Cancer Surgeons Performing Dynamic Sentinel Lymph Node Biopsy and Radical Inguinal Lymph Node Dissection in Men with Penile Cancer: A eUROGEN Survey. EUR UROL SUPPL 2021; 24:39-42. [PMID: 34337494 PMCID: PMC8317807 DOI: 10.1016/j.euros.2020.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/22/2022] Open
Abstract
Dynamic sentinel lymph node biopsy (DSNB) and radical inguinal lymph node dissection (ILND) are important in the management of penile cancer patients, but high-level evidence for preoperative, perioperative, and postoperative management remains scarce. According to an online survey of 35 surgeons from ten European countries, 57% perform >10 ILND procedures per year and 86% offer DSNB. Furthermore, management differs substantially for dye injection site, use of lymphoscintigraphy, preferred incision sites, techniques for lymphatic control, duration of empiric antibiotic therapy, perioperative thromboprophylaxis, time points for drain removal, and definition of the ILND dissection floor. Consensus was observed for the use of perioperative antibiotics (although not duration and type) and the borders for ILND template definitions. We conclude that there is significant variation in patient management among eUROGEN penile cancer surgeons. This heterogeneity may confound multicentre studies; therefore, a consensus to standardise inguinal node management in penile cancer across European penile cancer centres is warranted. Patient summary Our survey reveals that preferences and surgical techniques for inguinal lymph node sampling and removal varies significantly between European penile cancer surgeons. Consensus is needed to standardise the management approach for penile cancer.
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Dargan D, Hindocha S, Hadlett M, Wright R, Beck D, McConville S, Hartley-Large D, Mortimer K, Brackley P. Groin dissections in skin cancer: Effect of a change in prophylactic antibiotic protocol. J Plast Reconstr Aesthet Surg 2020; 74:1553-1561. [PMID: 33551360 DOI: 10.1016/j.bjps.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 09/14/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether groin dissection surgical site infection (SSI) incidence changed with shorter post-operative antibiotic prophylaxis. BACKGROUND Post-operative prophylaxis changed due to antimicrobial stewardship, from regular oral antibiotics until drain removal, to three intravenous doses. Both groups had a single intravenous dose at induction. METHODS A prospective database of groin dissections for metastatic skin cancer was retrospectively reviewed for SSI according to Public Health England criteria. Eighty groin dissections in 79 consecutive patients were included: 40 had oral antibiotics until drain removal [mean 26±7 (range 19-36) days] and 39 had three post-operative intravenous doses. RESULTS Longer prophylaxis was associated with lower SSI incidence [10 (25%) versus 21 (54%), odds ratio (OR) 3.50, 95% confidence interval (CI) 1.34-9.08, p = 0.009], fewer deep infections [5 (13%) versus 16 (41%), OR 4.89, 95% CI 1.57-15.13, p = 0.004], fewer readmissions for infection [5 (13%) versus 15 (38%), OR 4.38, 95% CI 1.40-13.65, p = 0.008], but similar seroma incidence [18 (45%) versus 16 (41%), OR 0.85, 95% CI 0.35-2.07, p = 0.72] and wound dehiscence [7 (18%) versus 5 (13%), OR 0.69, 95% CI 0.20-2.40, p = 0.56]. BMI ≥30 (n = 21) was associated with SSI, occurring in 13 of 21 (62%) (OR 3.859, 95% CI 1.34-11.10, p = 0.01). Median infection onset was 22 days (IQR 12-27) versus 17 (IQR 13-22), (p = 0.53). Multiple organisms were cultured in 21 of 31 (68%) patients with positive microbiological samples. CONCLUSIONS SSI rates doubled with shorter prophylaxis; deep infections and readmissions for infection tripled. Obesity was independently associated with infection. Seroma and wound dehiscence incidence were unchanged. Infections mainly occurred in the third week after surgery and were polymicrobial.
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Affiliation(s)
- Dallan Dargan
- Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom.
| | - Sandip Hindocha
- Plastic Surgery & Laser Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, United Kingdom
| | - Max Hadlett
- School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool L69 3GE, United Kingdom
| | - Rosanna Wright
- Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom
| | - Deborah Beck
- Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom
| | - Sarah McConville
- Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom
| | - David Hartley-Large
- Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom
| | - Kalani Mortimer
- Departments of Microbiology and Infection Prevention, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom
| | - Philip Brackley
- Mersey Regional Burns and Plastic Surgery Centre, St. Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Warrington Road, Prescot L35 5DR, United Kingdom
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Minimally invasive inguinal lymph node dissection: initial experience and reproducibility in a limited resource setting-with technique video. Surg Endosc 2020; 34:4669-4676. [PMID: 32681375 DOI: 10.1007/s00464-020-07813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/10/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Conventional inguinal lymph node dissection comes with a high wound complication rate which increases hospital stay and may delay adjuvant treatment. Minimally invasive lymph node dissection (MILND) is a novel endoscopic technique which aims to minimize complications of lymphadenectomy. Herein we present our technique and experience with MILND to examine safety, feasibility and reproducibility in a setting of limited resources. METHODS All patients undergoing MILND in the National Cancer Institute, Cairo were prospectively included following informed consent, IRB and ethical committee approval. Demographics, clinical, pathological data and postoperative complications according to Clavien-Dindo classification were recorded. Footage collected was used to create a step-by-step video demonstrating the technique. RESULTS Twenty-seven procedures were included in the study. The most common indications were vulval cancer (44%) and skin melanoma (19%). There were 5 (18%) conversions to open procedure, all of them in the first 10 cases of the learning curve. The median (range) operative time was 120 (45-240) min and there was a trend towards shorter operative time after the first 5 cases. Wound dehiscence occurred in 4 cases (15%). Three of them (11%) required reoperation (grade III). Grade I/II complications in the form of seroma and wound infection occurred in 34%. The median (range) postoperative hospital stay was 2 (1-14). The median (range) number of retrieved lymph nodes was 12 (3-19). No grade III/IV lymphedema was recorded at 90 days after surgery. CONCLUSION MILND is a safe, feasible technique associated with relatively low postoperative wound complications even when performed in a centre with relatively limited resources.
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Robot-assisted endoscopic inguinal lymphadenectomy: A review of current outcomes. Asian J Urol 2020; 8:20-26. [PMID: 33569269 PMCID: PMC7859461 DOI: 10.1016/j.ajur.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/11/2020] [Accepted: 05/28/2020] [Indexed: 12/27/2022] Open
Abstract
Objective To review the role of robot-assisted endoscopic inguinal lymphadenectomy (RAIL) in the management of penile cancer. Methods A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword “robotic”, “inguinal lymph node dissection”, and “penile cancer”. Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting factor. Results We identified 23 articles, of note the three largest series that included 102, 27, and 20 RAIL in 51, 14, and 10 patients, respectively. Saphenous vein was spared in 88.93% of RAIL cases in these series and node yield was 11.42 per groin; 35.28% of patients had positive pathological nodes. The weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per patient. The mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days; the major complication rate was only 5.31% in these series. The mean follow-up was 33.46 months with a recurrence-free survival of 96.33%. Conclusion The literature regarding RAIL describes promising results, although it has shorter follow-up and higher costs when compared to historically series from the open approach. Initials series reported lower cutaneous complications compared to conventional approach, without compromising oncological outcomes. However, long-term results and larger trials are crucial to validate those findings.
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Gerken ALH, Herrle F, Jakob J, Weiß C, Rahbari NN, Nowak K, Karthein C, Hohenberger P, Weitz J, Reißfelder C, Dobroschke JC. Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection. Langenbecks Arch Surg 2020; 405:697-704. [PMID: 32816115 PMCID: PMC7449944 DOI: 10.1007/s00423-020-01927-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
Purpose Lymphatic complications occur frequently after radical inguinal lymph node dissection (RILND). The incidence of lymphatic leakage varies considerably among different studies due to the lack of a consistent definition. The aim of the present study is to propose a standardized definition and grading of different types of lymphatic leakage after groin dissection. Methods A bicentric retrospective analysis of 82 patients who had undergone RILND was conducted. A classification of postoperative lymphatic leakage was developed on the basis of the daily drainage output, any necessary postoperative interventions and reoperations, and any delay in adjuvant treatment. Results In the majority of cases, RILND was performed in patients with inguinal metastases of malignant melanoma (n = 71). Reinterventions were necessary in 15% of the patients and reoperations in 32%. A new classification of postoperative lymphatic leakage was developed. According to this definition, grade A lymphatic leakage (continued secretion of lymphatic fluid from the surgical drains without further complications) occurred in 13% of the patients, grade B lymphatic leakage (persistent drainage for more than 10 postoperative days or the occurrence of a seroma after the initial removal of the drain that requires an intervention) in 28%, and grade C lymphatic leakage (causing a reoperation or a subsequent conflict with medical measures) in 33%. The drainage volume on the second postoperative day was a suitable predictor for a complicated lymphatic leakage (grades B and C) with a cutoff of 110 ml. Conclusion The proposed definition is clinically relevant, is easy to employ, and may serve as the definition of a standardized endpoint for the assessment of lymphatic morbidity after RILND in future studies.
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Affiliation(s)
- Andreas Lutz Heinrich Gerken
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Jakob
- Department of General, Visceral and Pediatric Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Christel Weiß
- Department of Biometry and Statistics, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of General Vascular and Thoracic Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, 83022, Rosenheim, Germany
| | - Constantin Karthein
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter Hohenberger
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jürgen Weitz
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jakob C Dobroschke
- Department of Visceral Surgery, University Hospital, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Current management and future perspectives of penile cancer: An updated review. Cancer Treat Rev 2020; 90:102087. [PMID: 32799062 DOI: 10.1016/j.ctrv.2020.102087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
Penile cancer (PeCa) is a rare disease worldwide, accounting for less than one percent of all malignancies in men. It usually presents as a painless ulcer or lump on the head of the penis. Squamous cell carcinoma represents the most common histological subtype of PeCa, with pathogenesis intimately linked to chronic Human Papilloma Virus (HPV) infection. Surgery is the cornerstone for the treatment of primary PeCa with potential mutilating outcome depending on the nodal extension of the disease. However, in case of extensive lymph node involvement, multidisciplinary treatment including perioperative chemotherapy and inclusion in clinical trial should be considered. To date, advanced or metastatic disease still have poor prognosis and are a therapeutic challenge with limited options, highlighting the need of new treatments and further investigations. Growing efforts to identify molecular alterations, understand the role of HPV and characterize immune contexture have expanded over the past years, providing further perspectives in prognostication, predictive biomarkers and therapeutic intervention. In this review, we provide an updated overview of current management of PeCa focusing on perioperative strategy. We discuss about new insights of the biology of PeCa and comment future directions in the field.
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Yu H, Lu Y, Xiao Y, Guo J, Yin X, Yang Y, Wang H, Gao J. Robot-assisted laparoscopic antegrade versus open inguinal lymphadenectomy: a retrospective controlled study. BMC Urol 2019; 19:135. [PMID: 31870347 PMCID: PMC6929478 DOI: 10.1186/s12894-019-0571-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the surgical methods and clinical results of robot-assisted laparoscopic antegrade inguinal lymphadenectomy. METHODS A retrospective study was performed on clinical data from 19 patients with penile cancer admitted from March 2013 to October 2017. Among them, nine patients underwent robot-assisted laparoscopic antegrade inguinal lymphadenectomy (robot-assisted group) and 10 patients underwent open inguinal lymphadenectomy (open group). In the robot-assisted group, preoperative preparation, patient position, robot placement, design of operating channel and establishment of operating space are described. Key surgical procedures and techniques are also summarized. In addition, the number of lymph nodes removed, postoperative complications and follow-up in both groups were statistically analyzed. RESULTS For the 9 patients in the robot-assisted group, surgery was successfully accomplished at 17 sides without intraoperative conversion to open surgery. The surgery time for each side was 45~90 min using laparoscope with an average of 68.5 ± 13.69 min/side. The intraoperative blood loss was estimated to be < 10 ml/side, and the number of removed lymph nodes was not significantly different from that of the open group (12 ± 4.2/side vs.11 ± 5.8/side, P = 0.84). There were no postoperative complications such as skin necrosis, delayed wound healing and cellulitis in the robot-assisted group. Skin-related complications occurred in 9 (45%) of the 20 sides in the open group. During a median follow-up of 25 months in robot-assisted group and 52.5 mouths in open group, was not significantly different there were no statistical differences in recurrence-free survival between the groups (75% vs 60%, p = 0.536). CONCLUSION Robot-assisted laparoscopic antegrade inguinal lymphadenectomy achieved the desired surgical outcomes with fewer intraoperative and postoperative complications. The robotic arms of the surgical system were placed between the lower limbs of each patient. There was no need to re-position the robotic arms during bilateral inguinal lymphadenectomy. This simplified the procedure and reduced the use of trocars. If necessary, pelvic lymphadenectomy could be performed simultaneously using the original trocar position.
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Affiliation(s)
- Hualiang Yu
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Yongliang Lu
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Yi Xiao
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Jiaxiang Guo
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Xiaotao Yin
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Yu Yang
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Hongwei Wang
- Department of Pathology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China
| | - Jiangping Gao
- Department of Urology, The Fourth Medical Center of Chinese PLA General Hospital, 51th Fucheng Street, Haidian District, Beijing, 100048, China.
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Maciel CVDM, Machado RD, Morini MA, Mattos PAL, Dos Reis R, Dos Reis RB, Guimarães GC, da Cunha IW, Faria EF. External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes. Int Braz J Urol 2019; 45:671-678. [PMID: 31136111 PMCID: PMC6837607 DOI: 10.1590/s1677-5538.ibju.2018.0756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/24/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. MATERIALS AND METHODS We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-oneout, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. RESULTS We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. CONCLUSIONS In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.
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Affiliation(s)
| | | | | | | | - Ricardo Dos Reis
- Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil
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Chipollini J, Garcia-Castaneda J, Harb-De la Rosa A, Cheriyan S, Azizi M, Spiess PE. Important surgical concepts and techniques in inguinal lymph node dissection. Curr Opin Urol 2019; 29:286-292. [DOI: 10.1097/mou.0000000000000591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ngendahayo E, Nzayirambaho M, Bonane A, Gasana G, Ssebuufu R, Umurangwa F, Muhawenimana E, Nyirimodoka A, Nzeyimana I, Rugwizangoga B, Muvunyi T, Musoni E, Bwogi S, Hategekimana T, Kalengayi R, Rwamasirabo E. Pattern and clinical management of penile cancer in Rwanda. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Savoie PH, Fléchon A, Morel-Journel N, Murez T, Ferretti L, Camparo P, Rocher L, Sèbe P, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : tumeurs du pénis. Prog Urol 2018; 28 Suppl 1:R133-R148. [DOI: 10.1016/j.purol.2019.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 10/26/2022]
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Savoie PH, Fléchon A, Morel-Journel N, Murez T, Ferretti L, Camparo P, Rocher L, Sèbe P, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020: tumeurs du pénis French ccAFU guidelines — Update 2018—2020: Penile cancer. Prog Urol 2018; 28:S131-S146. [PMID: 30361138 DOI: 10.1016/j.purol.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.008.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.008.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, centre hospitalier Lyon Sud (Pierre Bénite), HCL groupement hospitalier du Sud, 69495 Pierre Bénite cedex, France
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHRU de Montpellier, 371, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, BP 50048, 33401 Talence cedex, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre de pathologie, 51, rue de Jeanne-D'Arc, 80000 Amiens, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, HU Paris Sud, site Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - P Sèbe
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, groupe hospitalier Diaconesses Croix Saint Simon, 125, rue d'Avron, 75020 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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Azizi M, Chipollini J, Peyton CC, Cheriyan SK, Spiess PE. Current controversies and developments on the role of lymphadenectomy for penile cancer. Urol Oncol 2018; 37:201-208. [PMID: 30301700 DOI: 10.1016/j.urolonc.2018.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/02/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023]
Abstract
Penile squamous cell carcinoma is a rare cancer in men. The main prognosticators of survival for penile cancer patients remain the presence and the extent of lymph node metastasis. While radical inguinal lymphadenectomy has been the cornerstone of regional lymph node management for many years, it is still associated with significant morbidity and psychological distress. Recent developments in penile squamous cell carcinoma management have been met with some controversy in the urologic oncology community. Herein, we review the current controversies and developments on the role of inguinal lymphadenectomy for penile cancer.
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Affiliation(s)
- Mounsif Azizi
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
| | - Juan Chipollini
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Charles C Peyton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Salim K Cheriyan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Mehralivand S, van der Poel H, Winter A, Choyke PL, Pinto PA, Turkbey B. Sentinel lymph node imaging in urologic oncology. Transl Androl Urol 2018; 7:887-902. [PMID: 30456192 PMCID: PMC6212622 DOI: 10.21037/tau.2018.08.23] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022] Open
Abstract
Lymph node (LN) metastases in urological malignancies correlate with poor oncological outcomes. Accurate LN staging is of great importance since patients can benefit from an optimal staging, accordingly aligned therapy and more radical treatments. Current conventional cross-sectional imaging modalities [e.g., computed tomography (CT) and magnetic resonance imaging (MRI)] are not accurate enough to reliably detect early LN metastases as they rely on size criteria. Radical lymphadenectomy, the surgical removal of regional LNs, is the gold standard of invasive LN staging. The LN dissection is guided by anatomic considerations of lymphatic drainage pathways of the primary tumor. Selection of patients for lymphadenectomy heavily relies on preoperative risk stratification and nomograms and, as a result a considerable number of patients unnecessarily undergo invasive staging with associated morbidity. On the other hand, due to individual variability in lymphatic drainage, LN metastases can occur outside of standard lymphadenectomy templates leading to potential understaging and undertreatment. In theory, metastases from the primary tumor need to pass through the chain of LNs, where the initial node is defined as the sentinel LN. In theory, identifying and removing this LN could lead to accurate assessment of metastatic status. Radiotracers and more recently fluorescent dyes and superparamagnetic iron oxide nanoparticles (SPION) are injected into the primary tumor or peritumoral and the sentinel LNs are identified intraoperatively by a gamma probe, fluorescent camera or a handheld magnetometer. Preoperative imaging [e.g., single-photon emission computed tomography (SPECT)/CT or MRI] after tracer injection can further improve preoperative planning of LN dissection. While sentinel LN biopsy is an accepted and widely used approach in melanoma and breast cancer staging, its use in urological malignancies is still limited. Most data published so far is in penile cancer staging since this cancer has a typical echelon-based lymphatic metastasizing pattern. More recent data is encouraging with low false-negative rates, but its use is limited to centers with high expertise. Current guidelines recommend sentinel LN biopsy as an accepted alternative to modified inguinal lymphadenectomy in patients with pT1G2 disease and non-palpable inguinal LNs. In prostate cancer, a high diagnostic accuracy could be demonstrated for the sentinel approach. Nevertheless, due to lack of data or high false-negative rates in other urological malignancies, sentinel LN biopsy is still considered experimental in other urological malignancies. More high-level evidence and longitudinal data is needed to determine its final value in those malignancies. In this manuscript, we will review sentinel node imaging for urologic malignancies.
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Affiliation(s)
- Sherif Mehralivand
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henk van der Poel
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alexander Winter
- University Hospital for Urology, Oldenburg Hospital, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Abstract
PURPOSE OF REVIEW We review recent advancements in staging and imaging of penile cancer, including surveillance after therapy. RECENT FINDINGS For cN0 patients, the sentinel lymph node biopsy is currently considered the preferred way for invasive staging. It has largely replaced other modalities such as staging inguinal lymphadenectomy. Its diagnostic value increases when combined with other staging modalities such as ultrasound with fine-needle aspiration cytology (US-FNAC) or fluorodeoxyglucose-PET with computed tomography (PET/CT). In patients with palpably suspicious nodes (cN+), imaging is more useful. PET/CT has shown good accuracy in a limited number of small studies. US-FNAC can confirm nodal metastatic disease. A staging inguinal lymphadenectomy is of therapeutic value but is associated with significant morbidity. Omitting staging inguinal lymphadenectomy was recently described; one study showed well tolerated use of sentinel lymph node biopsy combined with intraoperative ultrasound-guided resection of suspicious nodes in cN+ patients. Therapeutic inguinal lymphadenectomy was only performed in the 42% of groins with metastases confirmed by disorder. For M-staging, PET/CT has shown good sensitivity, and its role should be further evaluated. Follow-up and surveillance rely on physical examination and US-FNAC. SUMMARY Over the past decade, staging and treatment of penile cancer have become less invasive, while survival tends to improve.
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Gkegkes ID, Minis EE, Iavazzo C. Robotic-assisted inguinal lymphadenectomy: a systematic review. J Robot Surg 2018; 13:1-8. [PMID: 29730734 DOI: 10.1007/s11701-018-0823-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/30/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lymphadenectomy represents the standard treatment for various types of cancer. The introduction of robotics in lymph node dissection may have an important impact on post-lymphadenectomy complications. METHODS A systematic literature review was performed. RESULTS In our review, robotic inguinal lymphadenectomy was performed on 51 patients. Penile squamous cell carcinoma was the most common histological type of the primary neoplasia. No intra-operative complications were reported. One case of conversion to open was reported. The mean duration of hospitalization was 2 days. The duration of drainage ranged from 7 to 72 days. The most common postoperative complications were lymphocele (13.7%), lymphedema (7.8%), cellulitis (7.8%), seroma (3.9%), abscess (3.9%), wound breakdown/wound infection (3.9%), sepsis (1.9%), prolonged lymphorrhea (1 out of 51 patients, 1.9%) and skin necrosis (1 out of 51 patients, 1.9%). CONCLUSIONS Until now there has not been sufficient evidence regarding the role of robotics in groin lymph node dissection, though this approach appears to be safe and oncologically effective, with morbidity rates relatively lower compared to open surgery.
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Affiliation(s)
- Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", 141, Oropou Str., Nea Ionia, 14232, Athens, Greece.
| | - Evelyn Eleni Minis
- First Department of Surgery, General Hospital of Attica "KAT", 141, Oropou Str., Nea Ionia, 14232, Athens, Greece
| | - Christos Iavazzo
- Gynaecological Oncology Department, Northampton General Hospital, Northampton, UK
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Singh A, Jaipuria J, Goel A, Shah S, Bhardwaj R, Baidya S, Jain J, Jain C, Rawal S. Comparing Outcomes of Robotic and Open Inguinal Lymph Node Dissection in Patients with Carcinoma of the Penis. J Urol 2018; 199:1518-1525. [PMID: 29307685 DOI: 10.1016/j.juro.2017.12.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE We compared outcomes between robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection in patients without bulky nodal metastasis in a tandem contemporary cohort. MATERIALS AND METHODS We retrospectively analyzed a prospectively maintained hospital registry of 51 patients who underwent robot-assisted video endoscopic inguinal lymphadenectomy and 100 treated with open inguinal lymph node dissection from 2012 to 2016 for groins without bulky nodal metastasis and who had a minimum 9-month followup. Complications were graded by the Clavien-Dindo classification, and nodal yield and disease recurrence during followup were assessed. Elastic net regression was used to select variables associated with major complications (Clavien 3a or greater) for multivariable analysis of plausible factors, including patient age, diabetes, body mass index, smoking, nodal stage, surgery type, sartorius transposition, saphenous vein transection and adjuvant radiotherapy. Penalized likelihood logistic regression methods were used for multivariate analysis to ascertain final effect sizes while accounting for sparse data bias. RESULTS Robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection had comparable median lymph node yields (13 vs 12.5). No patient experienced recurrence during the median followup of 40 months. Robot-assisted video endoscopic inguinal lymphadenectomy was associated with significantly lower hospital stay, days needing a drain in situ, incidence of major complications, edge necrosis, flap necrosis and severe limb edema. On multivariable analysis pathological nodal stage (OR 2.8, 95% CI 1.1-6.8, p = 0.027) and open inguinal lymph node dissection (OR 7.5, 95% CI 1.3-43, p = 0.024) emerged as independent risk factors associated with an increased risk of major complications. CONCLUSIONS Robot-assisted video endoscopic inguinal lymphadenectomy is a feasible technique which allows for a similar nodal yield while being associated with lower morbidity than open inguinal lymph node dissection in patients without bulky groin adenopathy.
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Affiliation(s)
- Amitabh Singh
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jiten Jaipuria
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Amit Goel
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Swati Shah
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Raghubir Bhardwaj
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Saroj Baidya
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Jalaj Jain
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Chirag Jain
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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Role of perioperative dynamic sentinel node biopsy for cN0 penile cancer management: experience from an Italian tertiary referral center. TUMORI JOURNAL 2017; 104:66-70. [PMID: 29192738 DOI: 10.5301/tj.5000700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Inguinal lymphadenectomy (iLAD) reduces mortality in patients with cN0 penile cancer but yields high complication rates. Thus, its prophylactic role has been questioned and dynamic sentinel node biopsy (DSNB) was introduced to select men who should undergo the procedure. Our aim was to investigate the accuracy of a contemporary DSNB cohort. METHODS We performed a retrospective analysis of ≥T1 or ≥G2 cN0 penile cancer undergoing perioperative DSNB from June 2009 to June 2015 at a tertiary referral center. We excluded men with <18 months follow-up or with local recurrence after primary curative treatment. Complications were graded according to the Clavien-Dindo classification. RESULTS Thirty-five men underwent DSNB; 85.71% had ≤T2 penile cancer with ≤G2a histology. Per groin detection rate was 80% (scintigraphy being positive bilaterally in 60% and unilaterally in 20.0%). In no cases did DSNB prolong the postoperative course compared to primary surgery. Nine men (n = 15/109 nodes removed) had positive results, 8 of whom underwent iLAD. Among negative DSNB patients, 2 developed nodal penile cancer recurrence; none of them had node biopsy due to inconclusive scintigraphy. At a median follow-up of 42 months (interquartile range 30-78 months), if considering only men with scintigraphy detected inguinal nodes, per-patient sensitivity and specificity were 50% and 80% whereas positive predictive value and negative predictive value were 25% and 92.3%, respectively. CONCLUSIONS Perioperative DSNB is a safe procedure, yielding promising results when performed at a tertiary referral center. Future prospective large studies are needed to investigate how to optimize detection rate and reduce false-negative rates.
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