Bilateral Inguinal Node Dissection Research Articles

Factor associated with postoperative complications of inguinal lymph node dissection for penile cancer Test

Background: Inguinal lymph node dissection (ILND) is the standard of care for palpable, biopsy-proven lymph node metastases or high-risk groups for nonpalpable lymph nodes in the treatment of penile cancer. ILND is associated with a significant incidence of complications and adverse events, specifically wound complications. Few studies have identified risk factors related to postoperative ILND complications. Objective: The objective of this study was to assess the prevalence of 30-day postoperative complications and to identify risk factors associated with postoperative complications of ILND for penile cancer. Materials and Methods: This was a retrospective review of medical records for all patients who had ILND for penile cancer between January 2012 and December 2022. According to the modified Clavien–Dindo classification, the 30-day postoperative complications were collected. Using an ordinal univariate logistic regression model and multivariate analysis, potential risk variables for complications were determined. Results: A total of 60 patients were performed ILND. Sixty percent of the patients had a postoperative complication including wound infection 50%, wound dehiscence 36.7%, skin necrosis 26.6%, lymphocele 33.3%, leg edema 46.7%, and scrotal edema 16.7%. Higher grade of modified Clavien–Dindo classification was associated with body mass index (BMI) (odds ratio [OR] = 1.15; P = 0.03), diabetes mellitus (OR = 3.13; P = 0.04), American Society of Anesthesiologist classification ≥3 (OR = 1.14; P = 0.03), radical ILND (OR = 1.57; P = 0.01), and bilateral ILND (OR = 1.60; P = 0.02). In multivariate analysis, a higher grade of modified Clavien–Dindo classification was correlated with BMI (OR = 1.48; P = 0.01) and bilateral ILND (OR = 4.56; P = 0.01). Conclusion: ILND is associated with high rates of complication. The severity of the modified Clavien–Dindo classification was associated with BMI and bilateral ILND.

Gradual and synergistic correlation of tumor thickness and histological grade in penile invasive carcinomas

Histological grade and depth of invasion are among the best outcome pathological predictors in penile cancer. The TNM system is based on a combination of both for some stages. It is assumed that high-grade and deep tumors carry the worst prognosis, and the opposite occurs with superficial and low-grade neoplasms. However, there is no systematic evaluation of the phenomenon. We studied 147 patients from the Hospital de Oncologia - Instituto Mexicano del Seguro Social (period 2000 to 2013). They were treated by total or partial penectomies. Lymph node involvement was evaluated by bilateral inguinal node dissection (126 cases) or ultrasonography (21 cases). Tumor thickness was measured in mm from tumor surface to deepest invasion point, using a cut-point for superficial (≤10 mm) vs deep (>10 mm) tumors. Histological grade was from 1 to 3 according to WHO and AFIP criteria and considering G1 and G2 as low-grade and G3 as high-grade. Average age was 62 (26–98) years old. Tumor thickness mean was 15 mm (2–30 mm). G1, G2 and G3 tumors corresponded to 19 (13 %), 48 (33 %), and 80 (54 %) cases, respectively. Follow-up ranged from 10 to 82 months (median: 57 months). Fifty-three (36 %) patients died of disease. There was an overall correlation of tumor thickness and grade in most of the cases. Low-grade tumors were encountered in 92 % (12/13 cases) of superficial tumors. Deep tumors showed high-grade in 75 % of cases (73/97 cases). Superficial tumors with low histological grade had negative inguinal nodes and no mortality whereas deep tumors showing high histological grade were associated with high metastatic risk to lymph nodes (62/73 cases) and mortality (52/73 cases). Out of 24 deep tumors with low histological grade, seven had nodal spread (29 %) but only one died of disease. No outcome difference was found in HPV associated vs HPV independent tumors. Tumor thickness and grade are important synergistic and predictive pathological factors in relation to prognosis.

Bilateral inguinal lymph-node dissection vs. unilateral inguinal lymph-node dissection and dynamic sentinel node biopsy in clinical N1 squamous cell carcinoma of the penis

To evaluate the role of unilateral inguinal lymph-node dissection (ILND) plus contralateral dynamic sentinel node biopsy (DSNB) vs. bilateral ILND in clinical N1 (cN1) penile squamous cell carcinoma (peSCC) patients. Within our institutional database (1980-2020, included), we identified 61 consecutive cT1-4 cN1 cM0 patients with histological confirmed peSCC who underwent either unilateral ILND plus DSNB (26) or bilateral ILND (35). Median age was 54 years (Interquartile range [IQR]: 48-60 years). Median follow-up was 68 months (IQR 21-105 months). Most patients had pT1 (23 %) or pT2 (54.1%), as well as G2 (47.5%) or G3 (23%) tumors, while lymphovascular invasion (LVI) was present in 67.1% of cases. Considering a cN1 and a cN0 groin, overall 57 out of 61 patients (93.5%) had nodal disease in the cN1 groin. Conversely, only 14 out of 61 patients (22.9%) had nodal disease in the cN0 groin. 5-year IR-free survival was 91% (Confidence interval [CI] 80%-100%) for bilateral ILND group and 88% (CI 73%-100%) for the ipsilateral ILND plus DSNB group (P-value 0.8). Conversely, 5-year CSS was 76% (CI 62%-92%) for bilateral ILND group and 78% (CI 63%-97%) for the ipsilateral ILND plus contralateral DSNB group (P-value 0.9). In patients with cN1 peSCC the risk of occult contralateral nodal disease is comparable to cN0 high risk peSCC and the gold standard, namely bilateral ILND, may be replaced by unilateral ILND and contralateral DSNB without affecting positive node detection, IRRs and CSS.

Current Approaches to the Management of Sentinel Node Procedures in Early Vulvar Cancer in Germany: A Web-Based Nationwide Analysis of Practices.

Lymph node involvement is the most important prognostic factor for recurrence and survival in vulvar cancer. Sentinel node (SN) procedure can be offered in well-selected patients with early vulvar cancer. This study aimed to assess current management practices with respect to the sentinel node procedure in women with early vulvar cancer in Germany. A Web-based survey was conducted. Questionnaires were e-mailed to 612 gynecology departments. Data were summarized as frequencies and analyzed using the chi-square test. A total of 222 hospitals (36.27%) responded to the invitation to participate. Among the responders, 9.5% did not offer the SN procedure. However, 79.5% evaluated SNs by ultrastaging. In vulvar cancer of the midline with unilateral localized positive SN, 49.1% and 48.6% of respondents, respectively, would perform ipsilateral or bilateral inguinal lymph node dissection. Repeat SN procedure was performed by 16.2% of respondents. For isolated tumor cells (ITCs) or micrometastases, 28.1% and 60.5% of respondents, respectively, would perform inguinal lymph node dissection, whereas 19.3% and 23.8%, respectively, would opt for radiation without further surgical intervention. Notably, 50.9% of respondents would not initiate any further therapy and 15.1% would opt for expectant management. The majority of German hospitals implement the SN procedure. However, only 79.5% of respondents performed ultrastaging and only 28.1% were aware that ITC may affect survival in vulvar cancer. There is a need to ensure that the management of vulvar cancer follows the latest recommendations and clinical evidence. Deviations from state-of-the-art management should only be after a detailed discussion with the concerned patient.

Prophylactic inguinal lymphadenectomy for high-risk cN0 penile cancer: The optimal surgical timing.

Few reports have investigated the oncologically safe timing of prophylactic inguinal lymphadenectomy for penile cancer patients with clinically normal inguinal lymph nodes (cN0), particularly those who received delayed surgical treatment. The study included pT1aG2, pT1b-3G1-3 cN0M0 patients with penile cancer who received prophylactic bilateral inguinal lymph nodes dissection (ILND) at the Department of Urology of Tangdu Hospital between October 2002 and August 2019. Patients who received simultaneous resection of primary tumor and inguinal lymph nodes were assigned to the immediate group, while the rest were assigned to the delayed group. The optimal timing of lymphadenectomy was determined based on the time-dependent ROC curves. The disease-specific survival (DSS) was estimated based on the Kaplan-Meier curve. Cox regression analysis was used to evaluate the associations between DSS and the timing of lymphadenectomy and tumor characteristics. The analyses were repeated after stabilized inverse probability of treatment weighting adjustment. A total of 87 patients were enrolled in the study, 35 of them in the immediate group and 52 in the delayed group. The median (range) interval time between primary tumor resection and ILND of the delayed group was 85 (29-225) days. Multivariable Cox analysis demonstrated that immediate lymphadenectomy was associated with a significant survival benefit (HR, 0.11; 95% CI, 0.02-0.57; p = 0.009). An index of 3.5 months was determined as the optimal cut-point for dichotomization in the delayed group. In high-risk patients who received delayed surgical treatment, prophylactic inguinal lymphadenectomy within 3.5 months was associated with a significantly better DSS compared to dissection after 3.5months (77.8% and 0%, respectively; log-rank p<0.001). Immediate and prophylactic inguinal lymphadenectomy in high-risk cN0 patients (pT1bG3 and all higher stage tumours) with penile cancer improves survival. For those patients at high risk who received delayed surgical treatment for any reason, within 3.5 months after resection of the primary tumor seems to be an oncologically safe window for prophylactic inguinal lymphadenectomy.

CLEAR CELL VARIANT OF SQUAMOUS CELL CARCINOMA PENIS – A CASE REPORT

Carcinoma penis is a rare malignancy in males. The World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs classifies squamous cell carcinoma of the penis into human papillomavirus (HPV) and non HPV related. Among the HPV-related Squamous cell carcinomas of the penis, clear cell variant is a rare. Here we report a case of clear cell variant of squamous cell carcinoma of penis with bilateral inguinal lymph node metastasis. We have treated this patient with radical surgery, wide excision and bilateral inguinal lymph node dissection followed by post operative chemo radiation. But during radiation itself the disease progressed, with rapid recurrence of inguinal lymph node metastasis, finally end up with palliative chemotherapy. Clear cell carcinoma is an aggressive form of cancer, with frequent metastasis to the inguinal lymph nodes, as seen in this case. Immunohistochemistry examination P16 was absent. So it is considered as clear cell variant of squamous cell carcinoma. Clinical experience with penile carcinoma is limited because of their rarity.

Defining the role of bilateral groin dissection for squamous cell carcinoma of the penis in South Africa

The current recommendation for the management of penile cancer is that all patients with palpable groin nodes should undergo a routine lymph node dissection (LND). This study reviews our yield from LND in patients with palpable lymph nodes (LNs) and penile cancer. All patients with a penile cancer, who presented to the urology departments of St Aidan's and Grey's hospitals in KwaZulu-Natal province (KZN) were reviewed. Clinical data records and histological reports of all the patients who underwent a penectomy and inguinal lymph node dissection (ILND) were analysed. A total of 93 cases of penile cancer were managed between 2014 and 2019. Of this total overall cohort, 38 patients had palpable groin nodes and underwent a bilateral ILND. The majority (84%) of these patients were human immunodeficiency virus (HIV) positive and none were circumcised. Tumour grade was mostly grade II (84%), and tumour size was an average of 6.2 cm with a range from 1.5 to 12 cm. The overall incidence of metastatic inguinal lymph nodes (ILNs) in the group undergoing dissection was 23.7%. In the remainder there was only reactive lymphadenopathy. ILND performed in patients with penile cancer and bilateral palpable ILN in our setting has a low yield. This might be a reflection on our high rate of HIV. Local validation of international cancer guidelines is essential prior to adopting them in the South African context.

STUDY OF PREDICTORS OF INGUINAL LYMPH NODE METASTASIS IN CARCINOMA PENIS

Background:Penile cancer although a rare cancer, its not uncommon in India. Indian incidence ranges from 0.7-3/100000 males.Clinical guidelines available for decision making, still it remains a complex issue as far as predicting the outcome. The presence of metastatic disease produces considerable morbidity in patients with penile cancer. By doing this study we want to study which factors both clinically and histologically were predictive of lymph node involvement, pattern of lymph node involvement and extent of disease in nodal regions. Patients and Methods:A total of 38 cases between January 2018 to February 2020 were included in study. Metastatic carcinoma penis were excluded. The study was conducted in the Department of surgical oncology MNJIO&amp;RCC OSMANIA MEDICAL COLLEGE.All cases of biopsy proven carcinoma penis were evaluated. Time period of study was from January 2018 to January 2020.Lymph node status was predicted preoperatively by clinical examination and imaging using ultra sound and CT scan. All cases irrespective of lymph node status were managed by surgery of primary and bilateral inguinal node dissection .Both clinical and histological factors were assessed. A total of 43 patients presented with penile cancer in the specified duration to our institute , of which, 1 patient had lung mets and was excluded, 2 patients were not willing for lymph nodal addressing surgery and were omitted from the study. Results: In our study post surgery 14 patients {35%} had positive lymph nodal disease of which 10 patients had unilateral inguinal lymph node involvement and 4 had bilateral inguinal lymph node involvement . 2 patients had pelvic lymph node involvement.Of the 40 cases in our study 23 patients had clinically involved nodes , 17 had no clinical involvement of lymph nodes . Of the 23 cases of clinically involved nodes 11 patients had histopathological conformation of nodal involvement {47.8%}. The relative risk of histopathological node positivity in clinical involved nodes is 2.71. odds ratio was 4.27 .The p value is 0.0479, so clinical node involvement is a significant criteria for pathological node involvement in our study. Conclusion:In clinically positive nodes only 50% of patients have actual histopathological involvement of disease. And 15 to 20% of patients with clinically negative nodes had post op histopathological confirmation of nodal involvement. Most significant predictive factors for lymphnode involvement in our study though with small sample size were tumor grade 3{poorly differentiated,tumor} ,depth of invasion greater than 1cm ,Clinical node involvement ,lymphovascular invasion. Other factors which had high relative risk and odds ratio were grade 2 tumor,size of greater than 4cms , perineural invasion, depth between 0.5 to 1cm.

V11-08 SINGLE-PORT ROBOTIC ANTEGRADE BILATERAL INGUINAL LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 May 2022V11-08 SINGLE-PORT ROBOTIC ANTEGRADE BILATERAL INGUINAL LYMPH NODE DISSECTION Nathan Cheng, Christopher Wright, Nizar Bou Diab, Mubashir Billah, and Mutahar Ahmed Nathan ChengNathan Cheng More articles by this author , Christopher WrightChristopher Wright More articles by this author , Nizar Bou DiabNizar Bou Diab More articles by this author , Mubashir BillahMubashir Billah More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002632.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High risk penile cancer following penectomy is often treated with inguinal lymph node dissection. Classically, inguinal lymph node dissections were performed by opening both inguinal regions, with risk of wound complications including skin break down, flap necrosis, and lymphatic complications such as lymphedema or lymphoceles. With the popularization of the single-port robotic system, novel surgeries have taken advantage of its ability to work in tight spaces. Here, bilateral inguinal lymph node dissection is performed through a single suprapubic incision using the single-port robot. The goals are to minimize wound complications associated with open inguinal lymph node dissections while maintaining safety and oncologic outcomes. METHODS: An 82-year-old male with T3 penile squamous cell carcinoma 4 months after recovery from a total penectomy with perineal urethrostomy was offered a single-port robotic antegrade bilateral inguinal lymph node dissection. The SP port was placed midline over the suprapubic region into the Space of Retzius similar to that of an extraperitoneal SP radical prostatectomy. Bilateral external iliac vessels were isolated and the spermatic cord was followed along its lateral edge distally until the inguinal ligament was seen. The external oblique aponeurosis was split anterior to the inguinal ligament, revealing the superficial compartment, where lymph nodes packets were retrieved. The deep compartment was then accessed by dissecting through fascia lata posteriorly and skeletonizing the femoral vessels. After completion of the deep inguinal lymph node dissection, bilateral 15 French drains were placed into both surgical sites. The abdominal wall fascial incision was closed with interrupted figure-of-8 absorbable sutures. RESULTS: Operative time was 3 hours and 16 minutes, with estimated blood loss 20 mL. The patient was discharged to home on post-op day 1 with both drains, which were then removed in 2 weeks. There was a total nodal yield of 15, all of which were negative for metastatic disease. There were no 30-day complications for this patient. CONCLUSIONS: An antegrade approach through a single suprapubic incision using the single-port robot gives excellent access to bilateral inguinal spaces that would be otherwise difficult with a multi-port robot. Larger case series should be performed, but its potential advantages include lower risk of wound complications, decreased risk of lymphatic complications, and access to pelvic lymph node dissection when appropriate. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e923 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Cheng More articles by this author Christopher Wright More articles by this author Nizar Bou Diab More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF DownloadLoading ...

Bilateral inguinal lymphadenectomy using simultaneous double laparoscopies for penile cancer: A retrospective study.

To assess the feasibility, safety, and efficiency of bilateral inguinal lymphadenectomy using simultaneous double laparoscopies for penile cancer. We reviewed retrospectively the records of 65 patients who underwent inguinal lymph nodes dissection (ILND) for penile cancer from January 2012 to May 2019. Treatments included open ILND (OILND, 19 patients), video-endoscopic inguinal lymphadenectomy (VEIL) using single laparoscopy (S-VEIL, 24 patients), and VEIL using double laparoscopies (D-VEIL, 22 patients). We evaluated the peri-operative and short-term oncological outcomes of the three groups. The mean operative time of D-VEIL (105.91 ± 10.87 minutes) was significantly shorter than the other two groups, OILND shorter than S-VEIL (160.47 ± 13.74 minutes, 191.67 ± 17.80 minutes, respectively) (P < 0.001). Intraoperative blood loss in the S-VEIL and D-VEIL groups were 53.54 ± 8.78 and 48.41 ± 13.22 ml, respectively; they were significantly lower than that of the OILND group (99.74 ± 9.64 ml; P < 0.001). The numbers of unilateral and total lymph nodes harvested were similar in all groups. The complication rates in the S-VEIL group (4.2%) and the D-VEIL group (4.5%) were significantly lower than that in the OILND group (63.2%; P < 0.001). Compared with open surgery (13.53 ± 1.74 days for hospitalization; 11.37 ± 1.92 days for the left side of drain, 11.95 ± 1.84 days for the right side), the two VEIL groups had significantly shorter drainage tube residence time (7.42 ± 2.02 and 7.32 ± 1.52 days, respectively for the left side; 7.63 ± 1.81 and 7.27 ± 1.58 days, respectively for the right side), shorter postoperative hospitalization (9.46 ± 1.64 and 9.00 ± 1.83 days, respectively) (P < 0.001). There were no statistically significant differences in rates of regional recurrence and short-term survival among the three groups. Bilateral inguinal lymphadenectomy using double laparoscopies simultaneously can provide adequate oncological outcomes safely and efficiently, and carry significantly lower morbidity than OILND, at a median follow-up of 33.5 months. It is a more time-saving surgical approach for penile cancer patients who need bilateral ILND.

Characterization of A Rare Case of Vulvar Epithelioid Sarcoma with local recurrence and metastases

Abstract Introduction/Objective Epithelioid sarcoma (ES) is a rare, malignant mesenchymal neoplasm that has a known tendency for local recurrence, regional lymph node involvement, and distant metastases. Two histologic variants have been recognized: classic ES also known as the distal type, and proximal-type ES (PES). The classic ES is common in young adults. It occurs more frequently in the distal upper extremities followed by the distal lower limbs and has a male prevalence of 2:1. Conversely, PES commonly involves deep tissues in the pelvic region, including the genital area. It tends to occur in older patients and follows a more aggressive clinical course. In the female genital tract, PES occurs most frequently in the vulva. The incidence of primary sarcoma of the vulva accounts for 1.5-5% of all malignant tumors, making PES a very rare incidence. Methods/Case Report Here we report a 60-year-old female diagnosed with vulvar epithelioid sarcoma treated with a right radical vulvectomy and bilateral inguinal lymph node dissection in 2008. In 2017, further surgery and adjuvant radiation were given for local recurrence. In 2020, the patient developed left hip pain and was found to have an expansile lytic lesion in the left proximal femur. Extensive resection was performed. Grossly the vulvar lesion was nodular with diffuse hemorrhage, degeneration, and necrosis. Microscopically, the tumor cells had large vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Histologically, the morphology of the tumor cells are similar for the primary vulvar specimen and the bone metastases. Immunohistochemically, the tumor cells are positive for vimentin, GATA, FLI-1, SMA, SMHC, partially positive for CAM5.2, AE1/AE3, CD31, and CD163. Immunohistochemistry was negative for CDX2, CD56, S-100, TTF-1, CK5/6, CK20, P40, mammoglobin, MOC31, ER, CK7, CK903, HMB45, PAX8. A Ki-67 proliferative index was around 30-40%. NGS molecular testing detected a SMARCB1 mutation with loss of exons 1-3 and exons 7-9 supporting the diagnosis of epithelioid sarcoma. Results (if a Case Study enter NA) NA Conclusion In summary, we report a case of PES of the vulva in a 60 year old female. Grossly, the lesion was nodular with histology showing large vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. It showed loss of INI1/SMARCB1 nuclear expression. The patient is receiving further adjuvant treatment and shows no new metastases.

Selection of surgical strategies for vulvar Paget's disease.

Selection of surgical strategies for vulvar Paget's disease.

PD53-04 IMAGE DIRECTED STRATIFICATION OF PATIENTS TO LYMPH NODE STAGING PROCEDURES IN PENILE CANCER IMPROVE OUTCOME? 10-YEAR STUDY IN &gt;150 PATIENTS

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer II (PD53)1 Sep 2021PD53-04 IMAGE DIRECTED STRATIFICATION OF PATIENTS TO LYMPH NODE STAGING PROCEDURES IN PENILE CANCER IMPROVE OUTCOME? 10-YEAR STUDY IN >150 PATIENTS Prakrit Kumar, Arne Juette, Davina Pawaroo, Richard Ball, Krishna Sethia, and Vivekanandan Kumar Prakrit KumarPrakrit Kumar More articles by this author , Arne JuetteArne Juette More articles by this author , Davina PawarooDavina Pawaroo More articles by this author , Richard BallRichard Ball More articles by this author , Krishna SethiaKrishna Sethia More articles by this author , and Vivekanandan KumarVivekanandan Kumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002080.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Survival in penile cancer is largely determined by lymph node (LN) metastasis. Dynamic Sentinel Node Biopsy (DSNB) staging procedure has a false negative rate of 5-13%. We use image directed stratification patients to LN staging procedures as opposed to palpability and report the outcomes including survival. METHODS: 158 consecutive patients (316 inguinal basins (IB)), who had lymph node surgery for penile cancer in a tertiary referral centre from Jan 2008 to 2018, were included in the study. All patients underwent ultrasound (US) +/-fine needle aspiration cytology (FNAC) and then MRI/ CT, if needed to stage their disease. We used combined clinical and radiological criteria to stratify patients for DSNB vs inguinal lymph node dissection (ILND). RESULTS: 241 IBs had DSNB due to clinically node negative disease (cN0) and 71 IBs had ILND due to abnormal nodes (cN+) and 4 IBs were observed due to non-drainage in sentinel node scan. 27(11.2%), 39 (54.9%) and 0 of those had nodes positive for metastasis respectively. The minimum and mean follow-up is 28 and 65 months respectively. FNR is 0%. All the 25 bilateral ILND patients had cross-sectional imaging. 13 had CT, 11 had MRI and 1 had both. Of the 108 DSNB patients, 30 had MRI, 34 had CT, and one both. 43 patients who had normal ultrasound (U1-2) and impalpable nodes did not have any cross-sectional imaging. Interestingly, only 2/43 (4.7%) patients who did not have cross-sectional imaging were DSNB-positive for micro-metastatic disease as opposed to 14/64 (21.9%) of imaged patients (p=0.03). 11 IBs in 9 patients had ILND dictated by cross-sectional imaging despite having negative US+FNAC and impalpable nodes. 3 IBs in 3 patients had metastatic disease on which 2 had CT and one MRI. We believe these 3 cases could have become a false negative in palpability+US FNAC protocols. Mean cancer specific survival (CSS) of all node-positive patients was 105 months. There was a difference in OS depending on which staging investigation was done at the outset (i.e., DSNB vs ILND (108 vs 72 months, p<0.0001). Further pN+ patients identified by DSNB had no significant difference in CSS compared to direct ILND patients (89 vs 92 months, p=0.124). CONCLUSIONS: Our enhanced clinical-radiological stratification criteria eliminated FNR for DSNB. Cross sectional imaging further sub stratifies patients in to 3 risk categories for micro-metastasis. Node positive patients had poor OS compared to node negative patients. However there was no difference in CSS in pN+ patients if either DSNB or ILND is used. This is first report of survival in lymph node staging in penile cancer. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e917-e917 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prakrit Kumar More articles by this author Arne Juette More articles by this author Davina Pawaroo More articles by this author Richard Ball More articles by this author Krishna Sethia More articles by this author Vivekanandan Kumar More articles by this author Expand All Advertisement Loading ...

Development and Validation of a Nomogram for the Prediction of Inguinal Lymph Node Metastasis Extranodal Extension in Penile Cancer.

PurposeTo determine whether a clinicopathologic and laboratory-based nomogram is capable of predicting the risk of lymph node extranodal extension (ENE) in patients with penile cancer.Materials and MethodsFrom June 2006 to January 2021, 234 patients who underwent bilateral inguinal lymph node dissection (ILND) surgery were included in the analysis. A Lasso regression model was utilized to select the most useful predictive features from among 46 laboratory variables. Then, a logistic regression analysis was used to develop the prediction model. Calibration curves, concordance index (C-index) and Areas under the receiver-operating characteristic curves (AUCs) were performed to evaluate the performance of the nomogram. We also investigated model fit using changes in Akaike Information Criteria (AICs). Decision curve analyses (DCAs) were applied to assess the clinical usefulness of this nomograms. Its internal validation was confirmed.ResultsAmong the 234 patients, 53 were confirmed to have ENE. The platelet-lymphocyte ratio (PLR) and Squamous cell carcinoma antigen (SCC-Ag) were significantly associated with ENE (P<0.05). The individualized prediction nomogram, including the PLR, SCC-Ag, lymphovascular invasion (LVI), and pathologic tumor stage(pT-stage), showed good discrimination, with a C-index of 0.817 (95% CI, 0.745 to 0.890) and good calibration. Clinical-laboratory nomogram (AIC, 180.034) become the best-fitting model. DCA findings revealed that the clinical-laboratory nomogram was more clinically useful than the pT-stage or tumor grade.ConclusionsThis study presents a clinicopathologic and laboratory-based nomogram that incorporates PLR, SCC-Ag, lymphovascular invasion (LVI), and pT-stage, which can be conveniently utilized to facilitate the individualized prediction of lymph node metastasis ENE in patients with penile cancer.

A Malignant Melanoma of the Penile : A Very Rare Case Report and Literature Review

Background: Malignant melanoma of the penis is very rare, accounting for approximately 1.4% of all primary penile carcinomas. With a small prevalence of penile melanoma, there is lack of data about quality of the therapy. The primary treatment of melanoma of the penile is surgical, although there is a lack of consensus regarding the extent of treatment that is indicated.&#x0D; Case Report: A 60-year-old Caucasian man came to Division of Urology, Department of Surgery, Dr. Kariadi General Hospital Semarang with chief complaint painless and fast growing lesions on his penile. His general condition was fine, and has a normal vital signs. On the physical examination of penile region, there were found lesions on the ventral of the glans and penile foreskin and covered with blood and pus, with bilateral inguinal lymph nodes and lung metastasis from Multi Slice Computed Tomography. We already performed partial penectomy and bilateral inguinal lymph nodes dissection with histopathological results a malignant melanoma Clark IV. The final stage of penile melanoma was pT2N1M1. We follow-up the patient until 1 year after procedure, and there wasn’t any recurrence.&#x0D; Conclusion: Malignant melanoma of the penis is rare. Penile melanoma is highly treatable with surgical excision in its early stages because of resistant to both chemotherapy and radiotherapy. Delay in diagnosed and surgical treatment can lead to an adverse prognosis. The anamnesis, physical examination, and imaging studies must be done appropriately to improve the survival.

A novel predictive model for pelvic lymph node metastasis in patients with penile cancer: A multi-institutional study

PurposeWe determined whether a clinicopathological nomogram is able to predict the risk of pelvic lymph node metastasis (LNM) in penile cancer patients after inguinal lymph node dissection (ILND). MethodsNinety-eight patients with bilateral ILND who underwent pelvic lymphadenectomy at 10 centers were retrospectively analyzed. The most predictive features in the nomogram were selected by the stepwise logistic regression method and then tested and verified by multivariate logistic regression analyses. The nomogram was assessed using concordance indices and calibration curves. ResultsOf the 181 pelvic basins, pelvic LNM was observed in 52 packages (43 patients). Bilateral pelvic LNM was present in 9 patients (9/43, 20.9%). There was no crossover metastatic spread from one inguinal side to the other pelvic side. Age, previous resection, the biopsy procedure for inguinal lymph nodes, vascular invasion, and ipsilateral inguinal lymph node status were all independent risk factors for pelvic LNM (all P < 0.05) in the multivariate logistic regression analysis. The nomogram exhibited a good probability for survival agreement, with a concordance index of 0.868 (95% CI: 0.813–0.922). ConclusionsA novel nomogram suggests that the risk of pelvic LNM can be effectively predicted in penile carcinoma patients and may provide a useful guide for clinicians. Further external validation is needed.

Underutilization of Surgical Standard of Care for Insured Men with Invasive Penile Cancer.

Prior studies of mixed insurance populations have demonstrated poor adherence to surgical standard of care (SOC) for penile cancer. We used data from the Surveillance, Epidemiology and End Results (SEER) cancer registry linked to Medicare to calculate SOC adherence to surgical treatment of penile cancer in insured men over the age of 65, focusing on potential social and racial disparities. This is an observational analysis of patients with T2-4 penile cancer of any histologic subtype without metastasis in the SEER-Medicare database (2004-2015). SOC was defined as penectomy (partial or radical) with bilateral inguinal lymph node dissection (ILND) based on the National Comprehensive Cancer Network guidelines. We calculated proportions of those receiving SOC and constructed multivariate models to identify factors associated with receiving SOC. A total of 447 men were included. Of these men, 22.1% (99/447) received SOC while 18.8% (84/447) received no treatment at all. Only 23.3% (104/447) had ILND while 80.9% (362/447) underwent total or partial penectomy. Race and socioeconomic status (SES) were not associated with decreased SOC. Increasing age (OR 0.93, 95%CI:0.89-0.96), Charlson Comorbidity Index score ≥ 2 (OR 0.53, 95%CI:0.29-0.97), and T3-T4 disease (OR 0.34, 95%CI:0.18-0.65) were associated with not receiving SOC on adjusted analysis. Rates of SOC are low among insured men 65 years of age or older with invasive penile cancer, regardless of race or SES. This finding is largely driven by low rates of ILND. Strategies are needed to overcome barriers to SOC treatment for men with invasive penile cancer.

A single-centre experience of the management of inguinal lymph nodes associated with penile squamous-cell carcinoma

Background: Twenty-two cases of penile carcinoma that were managed at our institution over a 5-year period were analysed on the basis of inguinal lymph node dissection (ILND), complications and follow-up. Methods: A total of 22 cases post penectomy were stratified into low risk (T1 G1 or G2 without lympho-vascular invasion and negative on fine-needle aspiration cytology (FNAC)) and high risk (T1 G3 and above and/or lympho-vascular invasion). Low-risk patients having palpable lymphadenopathy were given a course of antibiotics. If the lymph nodes were still palpable, FNAC was done, and patients then underwent superficial ILND (SILND) or even ILND in cases with positive frozen-section reports. In the high-risk group, all patients underwent SILND, and if required, underwent ILND. Two patients in the high-risk group were lost to follow-up after 9 months. Histopathology reports were noted, and patients were followed up for 2 years. Results: In the low-risk group, seven patients had palpable lymph nodes and underwent SILND. The remaining five patients were put on surveillance. Amongst the seven who underwent SILND, six were positive at frozen section, requiring ILND. Nine patients in the high-risk group underwent ILND. Four patients in the ILND group had a minor wound infection. Lymphoedema was seen in two patients which was managed conservatively, and lymphorrhoea was seen in one patient. Flap necrosis occurred in one patient. Recurrences were seen in three patients in the high-risk group. Two who had deep node involvement and who had early nodal recurrence underwent bilateral ILND. One patient in the high-risk group had late ipsilateral nodal recurrence and underwent ipsilateral ILND. There were no regional recurrences. Conclusion: Carcinoma of the penis has high morbidity because of delayed presentation, lack of awareness and poor compliance. This necessitates staging SILND in all high-risk cases for therapeutic and prognostic purposes.

V093 - Robot assisted simultaneous bilateral video endoscopic inguinal lymph node dissection (VEIL) with preservation of both saphenous veins. Is it feasible? A video demonstration

V093 - Robot assisted simultaneous bilateral video endoscopic inguinal lymph node dissection (VEIL) with preservation of both saphenous veins. Is it feasible? A video demonstration

Final results of the Pr\xe4VAC trial: prevention of wound complications following inguinal lymph node dissection in patients with penile cancer using epidermal vacuum-assisted wound closure

PurposeInguinal lymphadenectomy in penile cancer is associated with a high rate of wound complications. The aim of this trial was to prospectively analyze the effect of an epidermal vacuum wound dressing on lymphorrhea, complications and reintervention in patients with inguinal lymphadenectomy for penile cancer.Patients and methodsProspective, multicenter, randomized, investigator-initiated study in two German university hospitals (2013–2017). Thirty-one patients with penile cancer and indication for bilateral inguinal lymph node dissection were included and randomized to conventional wound care on one side (CONV) versus epidermal vacuum wound dressing (VAC) on the other side.ResultsA smaller cumulative drainage fluid volume until day 14 (CDF) compared to contralateral side was observed in 15 patients (CONV) vs. 16 patients (VAC), with a median CDF 230 ml (CONV) vs. 415 ml (VAC) and a median maximum daily fluid volume (MDFV) of 80 ml (CONV) vs. 110 ml (VAC). Median time of indwelling drainage: 7 days (CONV) vs. 8 days (VAC). All grade surgery-related complications were seen in 74% patients (CONV) vs. 74% patients (VAC); grade 3 complications in 3 patients (CONV) vs. 6 patients (VAC). Prolonged hospital stay occurred in 32% patients (CONV) vs. 48% patients (VAC); median hospital stay was 11.5 days. Reintervention due to complications occurred in 45% patients (CONV) vs. 42% patients (VAC).ConclusionsIn this prospective, randomized trial we could not observe a significant difference between epidermal vacuum treatment and conventional wound care.