945 VERIFICATION OF SENTINEL LYMPHADENECTOMY IN PENILE CANCER IN CONSIDERATION OF THE EUROPEAN GUIDELINES

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (III)1 Apr 2013945 VERIFICATION OF SENTINEL LYMPHADENECTOMY IN PENILE CANCER IN CONSIDERATION OF THE EUROPEAN GUIDELINES Alexander Winter, Jens Uphoff, Rolf-Peter Henke, and Friedhelm Wawroschek Alexander WinterAlexander Winter Oldenburg, Germany More articles by this author , Jens UphoffJens Uphoff Oldenburg, Germany More articles by this author , Rolf-Peter HenkeRolf-Peter Henke Oldenburg, Germany More articles by this author , and Friedhelm WawroschekFriedhelm Wawroschek Oldenburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In penile cancer the absence of lymph node (LN) metastases is the most important prognostic factor. Patients without LN metastases have a long-term survival of up to 90% whereas in the case of LN metastases the 5-year survival rate drops below 30%. Patients with LN metastases and only a small tumor burden can be cured surgically. Therefore, in penile cancer the significance of lymphadenectomy is high. This contrasts with the large morbidity of extended inguinal lymphadenectomy or over-treatment of many patients. The guidelines of the European Association of Urology recommend the minimally invasive sentinel-guided lymphadenectomy from a tumor stage ≥T1G2. We analyzed the reliability of inguinal sentinel lymphadenectomy in our own collective. METHODS 29 patients with penile cancer who had received surgical treatment (circumcision, partial resection of the penis or penectomy, 11/2004 - 06/2010) were included. The tumor stages varied from T1 to T3 (G1-3). 22 patients (mean 63, range 42 - 83 years) with a tumor stage ≥T1G2 received an inguinal sentinel lymphadenectomy and stage adapted additionally a modified inguinal lymphadenectomy. The sentinel tracer (Technetium99mNanocolloid) was injected preoperatively peritumoral (n= 11) or in a two-step procedure in the area of the resection (n= 10). In one patient primary a radical inguinal lymphadenectomy was performed. In this case no sentinel LN could be detected intraoperatively. Patients with positive sentinel LN received a secondary radical inguinal lymphadenectomy in pN1 stage or a inguinal and pelvic lymphadenectomy in pN2 stage. LN negative patients received only an aftercare. RESULTS In 19 of the 22 cases with lymphadenectomy no LN metastases were detected. Of the 3 patients with positive sentinel LN one had a pN1 stage (pN1 (mi) (3/5 LN)) and two a pN2 stage (pN2 (2/5 or 5/23 LN)). In the secondary radical inguinal lymphadenectomy (0/18 LN) or inguinal and pelvic lymphadenectomy (0/31 LN or 0/35 LN) no additional metastases were detected. In the follow-up (median 37 month; range 10 - 78 months) 20 patients were free of recurrence (including one patient with pN1 and pN2) and one patient lost to follow-up. One patient (pN2) died of progressive lymphatic dissemination and two patients of other causes. CONCLUSIONS The minimally invasive sentinel-guided inguinal lymphadenectomy showed reliable results in our collective. By their use the number of extended inguinal lymphadenectomy can be reliably reduced. Patients are spared from higher postoperative morbidity. Thereby the tumor-surgical results are excellent. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e388-e389 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Winter Oldenburg, Germany More articles by this author Jens Uphoff Oldenburg, Germany More articles by this author Rolf-Peter Henke Oldenburg, Germany More articles by this author Friedhelm Wawroschek Oldenburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...