927 DYNAMIC SENTINEL LYMPH NODE BIOPSY AT THE TIME OF PRIMARY SURGERY FOR PENILE CANCER; IMPACT ON MORBIDITY AND OUTCOME

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2012927 DYNAMIC SENTINEL LYMPH NODE BIOPSY AT THE TIME OF PRIMARY SURGERY FOR PENILE CANCER; IMPACT ON MORBIDITY AND OUTCOME Srijit Banerjee, Muhammad Rafiq, Krishna Sethia, and Vivekanandan Kumar Srijit BanerjeeSrijit Banerjee Norwich, United Kingdom More articles by this author , Muhammad RafiqMuhammad Rafiq Norwich, United Kingdom More articles by this author , Krishna SethiaKrishna Sethia Norwich, United Kingdom More articles by this author , and Vivekanandan KumarVivekanandan Kumar Norwich, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detecting micro metastases by DSNB offers a survival advantage in clinically node-negative (cN0) patients with penile cancer whilst potentially avoiding the morbidity of inguinal lymphadenectomy in patients with high-and intermediate-risk disease. The timing of DSNB has traditionally been as second stage following the primary surgery. However DSNB at the time primary surgery avoids additional morbidity. But the oncological safety and the impact on primary site are unknown. METHODS Data was collected prospectively over a 20 month period for patients who underwent surgery for penile cancer at a tertiary referral centre. DSNB is offered if the primary histology is >G2PT1 SCC and cN0 unless a gross infection at primary site. DSNB and primary surgery were done at the same sitting. Follow-up was by regular clinical examination and selective ultrasound FNA of groin. RESULTS 39 patients with an average age of 70years (range 43-93) underwent surgery for penile cancer.37 patients had penile length conserving surgery of which 2 had local recurrence and eventually 4 had total penectomy. 16 patients had lymph node surgery. The timing of surgery and type of lymph node surgery are listed in Table 1. Table 1. Details of lymphnode surgery Type of LN surgery Total no of groins (patients) LN surgery at the time of primary surgery As a second stage operation Bilateral DSNB 14(7) 12(6) 6(1) Bilateral DSNB + Validation MLND⁎⁎ 9(5⁎) 6(3) 3(2) Left DSNB 2(2) 2 0 MLND⁎⁎ 5(3) 0 5(3) ⁎ one patient had DSNB on right and MLND on the left ⁎⁎ Modified Lymph node dissection 3/6 patients who had combined primary and lymph node surgery had transient scrotal oedema. However it did not have an effect on the primary surgery (ie skin graft). With 4-20 months follow-up false negative rate is 0% so far. CONCLUSIONS DSNB is both minimally invasive and accurate and does not have the co morbidity of lymphadenectomy. Thus it is increasingly being adopted for management of clinically node negative moderate and high grade penile cancers. By performing the DSNB at the time of primary surgery we have avoided the risk of GA and further surgery. The initial data show that there are no false negative results by adopting this approach. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e377 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Srijit Banerjee Norwich, United Kingdom More articles by this author Muhammad Rafiq Norwich, United Kingdom More articles by this author Krishna Sethia Norwich, United Kingdom More articles by this author Vivekanandan Kumar Norwich, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...