592 IS PELVIC LYMPH NODE DISSECTION FOR PN2 PENILE CANCER NECESSARY?

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011592 IS PELVIC LYMPH NODE DISSECTION FOR PN2 PENILE CANCER NECESSARY? Majid Shabbir, C.J. Shukla, Evangelos Zacherakis, K.J. Ho, Raj Nigam, Peter Malone, Alex Freeman, David Ralph, Asif Muneer, and Suks Minhas Majid ShabbirMajid Shabbir London, United Kingdom More articles by this author , C.J. ShuklaC.J. Shukla London, United Kingdom More articles by this author , Evangelos ZacherakisEvangelos Zacherakis London, United Kingdom More articles by this author , K.J. HoK.J. Ho London, United Kingdom More articles by this author , Raj NigamRaj Nigam London, United Kingdom More articles by this author , Peter MalonePeter Malone London, United Kingdom More articles by this author , Alex FreemanAlex Freeman London, United Kingdom More articles by this author , David RalphDavid Ralph London, United Kingdom More articles by this author , Asif MuneerAsif Muneer London, United Kingdom More articles by this author , and Suks MinhasSuks Minhas London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1424AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES EAU guidelines state that penile cancer patients with pN2 disease should undergo a pelvic lymph node dissection (PLND). The aim of this study was to assess the detection rate, outcome and histopathological trends of patients who underwent PLND for pN2 disease. METHODS We reviewed all penile cancer cases treated in our institution between 2000 and 2010. Histological grade, tumour subtype, stage, presence of lymphovascular invasion (LVI), number of positive inguinal lymph nodes (ILN) and presence of extra nodal spread (ENS) were assessed and correlated with PLN status and outcome data. Fisher's exact test and unpaired t tests were used for analysis, and p values < 0.05 were taken as statistically significant. RESULTS 34 patients were identified with pN2 disease. 14 (41%) had no PLND as they were either unfit for surgery (4/14–28%) or had advanced metastatic disease treated with palliative chemo/radiotherapy (8/14–58%). 2/14 patients (14%) opted for surveillance. 9/14 patients (65%) in this group died after a median of 218 days (33–1110 days). 20 patients (59%) underwent PLND; 4/20 (20%) were found to have metastatic disease in the pelvic lymph nodes. All positive PLN's occurred on the same side as the positive ILN's. 2/4 (50%) of these patients died after a median of 1233 days (335–2132 days). 16/20 patients (80%) had no metastatic disease in the pelvic lymph nodes. 6/16 patients in this group (38%) died after a median of 476 days (324–912 days). Histological grade, tumour subtype, LVI status, and the presence of ENS were not significantly associated with PLN status. However, patients with positive PLN did have significantly more ILN involvement (mean 5.5 vs. 2.6 nodes, p=0.03). Mortality was not significantly associated with PLN status. However, presence of ENS was a significant predictor of death independent of PLN status (p=0.02). There were no significant differences in the survival data of those undergoing PLND vs. those who did not (overall mortality and median survival; PLND group 50% and 476 days vs. 65% and 218 days, p=0.11). CONCLUSIONS PLND has a low yield in pN2 disease, detecting metastases in only 20% of cases. Despite theoretical bilateral drainage, metastatic PLN were only detected on the ipsilateral side as the positive ILN's and this may have implications for the extent of the PLND performed. Overall mortality was not associated with PLN status, but the presence of ENS on ILND was a significant independent predictor of death. PLND itself did not confer any significant survival advantage, although this may be related to the sample size in this series. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e239 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Majid Shabbir London, United Kingdom More articles by this author C.J. Shukla London, United Kingdom More articles by this author Evangelos Zacherakis London, United Kingdom More articles by this author K.J. Ho London, United Kingdom More articles by this author Raj Nigam London, United Kingdom More articles by this author Peter Malone London, United Kingdom More articles by this author Alex Freeman London, United Kingdom More articles by this author David Ralph London, United Kingdom More articles by this author Asif Muneer London, United Kingdom More articles by this author Suks Minhas London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...