Lymphadenectomy For Penile Cancer Research Articles

Neoadjuvant Platinum-Based chemotherapy and lymphadenectomy for penile cancer: an international, Multi-Institutional, Real-World study.

This study investigated the efficacy and safety of neoadjuvant chemotherapy (NAC) for locally advance penile squamous cell carcinoma (PSCC), for which current evidence is lacking. Included patients had locally advanced PSCC with clinical lymph node metastasis treated with at least one dose of NAC prior to planned consolidative lymphadenectomy. Objective response rates (ORR) were assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. The primary and secondary outcomes were overall survival and progression-free survival, estimated by the Kaplan-Meier method. Treatment-related adverse events (trAEs) were graded per the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. 209 patients received NAC for locally advanced and clinically node-positive PSCC.The study population consisted of 7% of patients with stage II disease, 48% with stage III, and 45% with stage IV. Grade 2 TrAEs occurred in 35 (17%) patients, and no treatment related mortality was observed. 201 (97%) completed planned consolidative lymphadenectomy. During follow up, 106 (52.7%) patients expired, with a median OS of 37.0 months (95% CI 23.8-50.1), and median PFS of 26.0 months (95% CI 11.7-40.2). ORR was 57.2%, with 87 (43.2%) having partial response and 28 (13.9%) having a complete response. Patients with objective response to NAC had a longer median OS (73.0 vs 17.0 months, p < .01) compared to those who did not. The lymph-node pathologic complete response rate (ypN0) was 24.8% in the cohort. NAC with lymphadenectomy for locally advanced PSCC is well tolerated and active to reduce the disease burden and improve long term survival outcomes.

Video 11 - Robotic assisted bilateral pelvic lymphadenectomy in penile cancer: A case report

Video 11 - Robotic assisted bilateral pelvic lymphadenectomy in penile cancer: A case report

A0688 - Morbidity following lymphadenectomy for penile cancer in a Swedish national cohort

A0688 - Morbidity following lymphadenectomy for penile cancer in a Swedish national cohort

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.

PD49-02 PREDICTION OF POSTOPERATIVE COMPLICATIONS AFTER INGUINAL LYMPHADENECTOMY FOR PENILE CANCER USING A NOVEL CLASSIFICATION TOOL

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2017PD49-02 PREDICTION OF POSTOPERATIVE COMPLICATIONS AFTER INGUINAL LYMPHADENECTOMY FOR PENILE CANCER USING A NOVEL CLASSIFICATION TOOL Yao Zhu, Wei-Jie Gu, Philippe Spiess, and Ding-Wei Ye Yao ZhuYao Zhu More articles by this author , Wei-Jie GuWei-Jie Gu More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , and Ding-Wei YeDing-Wei Ye More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2226AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To develop and validate a preoperative radiological assessment tool for predicting complications following inguinal lymph node dissection (ILND) in penile cancer patients. METHODS Patients treated at Fudan University Shanghai Cancer Center (n=175) and Moffitt Cancer Center (n=28) were used for prediction assessment and repetition, respectively. The ILN complexity score (ILCS) included 5 radiological features of ILNs and surrounding adipose tissue. A tertiary (low/moderate/high) classification was assigned according to the sum score. Postoperative complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the odd ratios (ORs) of the ILCS for predicting overall and major (grade=2) complications. RESULTS In the primary cohort, overall and major complications were observed in 47.4% and 20.5% of patients, respectively. Controlling for covariates, the moderate and high scores had 2.73 (p=0.02) and 4.61-fold (p=0.01) increased risks of overall complications compared with the low score. For predicting major complications, the adjusted OR was 3.48 for the moderate score (p=0.02), and 17.01 for the high score (p<0.01), using the low score as a reference. The predictive accuracy of the ILCS for overall and major complications was 0.63 (0.56-0.70) and 0.73 (0.64-0.82), respectively. In the repetition cohort, the ILCS was significantly associated with major complications (OR=17.33, p=0.02) and showed a predictive accuracy of 0.79 (0.64-0.93). CONCLUSIONS Using structured radiological measurements of the inguinal nodal basin, the ILCS provided accurate risk estimation of overall and major complications after ILND for penile cancer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e973-e974 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yao Zhu More articles by this author Wei-Jie Gu More articles by this author Philippe Spiess More articles by this author Ding-Wei Ye More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

EP177 - It is possible to decrease morbidity and mortality in the lymphadenectomy in penile cancer? Description of a new minimally invasive technique

EP177 - It is possible to decrease morbidity and mortality in the lymphadenectomy in penile cancer? Description of a new minimally invasive technique

61 The role of lymph node count and node density after lymphadenectomy for penile cancer

61 The role of lymph node count and node density after lymphadenectomy for penile cancer

59 Endoscopic inguinal lymphadenectomy for penile cancer: Long-term follow-up

59 Endoscopic inguinal lymphadenectomy for penile cancer: Long-term follow-up

Robotic Bilateral Inguinal Lymphadenectomy in Penile Cancer, Development of a Technique Without Robot Repositioning: A Case Report

Abstract Introduction: Inguinal lymphadenectomy is the treatment of choice for patients with penile cancer and inguinal lymph node metastases. We describe the performance of robotic bilateral ingui...

S272 Our experience from complications in inguinal and pelvic lymphadenectomy for penile cancer

S272 Our experience from complications in inguinal and pelvic lymphadenectomy for penile cancer

Characterisation of antibody responses to Gal-positive and Gal-free biological heart valves

Characterisation of antibody responses to Gal-positive and Gal-free biological heart valves

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

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 ...

Early Wound Complications After Inguinal Lymphadenectomy in Penile Cancer: A Historical Cohort Study and Risk-factor Analysis

BackgroundComplication rates after inguinal lymph node dissection (ILND) are high. Risk factors for early wound complications after ILND in patients with penile carcinoma have not yet been studied. ObjectivesTo assess the frequency of early wound complications in a contemporary series and to identify clinical risk factors for early wound complications after ILND for penile carcinoma. Design, setting, and participantsWe evaluated 237 ILNDs in 163 patients with penile cancer treated between 2003 and 2012 at the Netherlands Cancer Institute. Outcome measurements and statistical analysisWe assessed the occurrence of wound infection, skin-flap problems, and seroma formation and graded complications using the modified Clavien system. Univariable and multivariable penalised mixed effects logistic regression was used to identify clinical risk factors for occurrence of any complication (grade ≥1) and of moderate to severe complications (grade ≥2). Results and limitationsOne complication or more occurred in 58% of the procedures, and 10% of those complications were severe. Wound infection occurred in 43%, seroma formation occurred in 24%, and skin-flap problems occurred in 16%.Palpable disease was the only factor associated with grade ≥1 complications in the univariable analysis (odds ratio [OR]: 0.43; p=0.02). In the multivariable model, after penalisation, no statistically significant risk factors remained.Univariable associations for grade ≥2 complications were present for body mass index (BMI; OR of 1.66 for a 5.8-point change in BMI; p=0.05) and sartorius muscle transposition (OR: 2.64; p=0.04). In the reduced multivariable model, the OR for sartorius muscle transposition was 2.12 (p=0.06) and for BMI was 1.76 (p=0.03). In addition, bilateral dissection approached significance in the multivariable model (OR: 2.17; p=0.06). This study is limited by its observational nature. ConclusionsWound complication rates after ILND are high in this cohort. BMI, sartorius muscle transposition, and bilateral dissection were the factors most strongly associated with the occurrence of grade ≥2 wound complications.

387 Surgical complications after inguinal lymphadenectomy in penile cancer – an explorative historical cohort study for risk factors

387 Surgical complications after inguinal lymphadenectomy in penile cancer – an explorative historical cohort study for risk factors

Therapeutic Strategies in Penile Cancer: State of the Art

A systematic review of the current treatment options and of the outcomes of penile carcinoma has been performed with special focus on controversial issues. A MedLine search using specified search terms was done during the period 1988 - January 2013. Demolitive surgery is considered as the "gold standard" treatment of invasive penile carcinoma staged higher than T2, but negative psychological outcomes were reported. On the other hand, conservative surgical techniques have been associated with higher recurrence rates. Potency-sparing technique (glansectomy and apexes sparing) preserves penile length: the reconstruction of glans anatomy and function is a key point to restore anatomy and sexual functions. Techniques such as glanduloplasty have given satisfactory anatomic, functional and sexual outcomes. Lymphadenectomy is indicated in any case of inguinal palpable nodes that persist after a course of antibiotic therapy, but also in all the cases staged T2 or higher, or in any high-grade penile cancer. It is still being debated the extension of inguinal lymphadenectomy for penile cancer: unilateral, bilateral, and extended to pelvic lymph nodes. Due to the specific radioresistance of penile cancer, radiation therapy is currently indicated in case of unresectable penile cancers with palliative intent. Chemotherapy is indicated as adjuvant therapy for stage T1-T3, N1-3, M0, or as neo-adjuvant therapy in the event of extensive pelvic and inguinal lymphadenopathies, or as palliative treatment in patients with unresectable or metastatic cancers. New chemotherapy agents such as Cis - platinum and Taxanes have shown promising results in early trials.

520 Anatomic aspects of inguinal lymph nodes applied to lymphadenectomy in penile cancer

520 Anatomic aspects of inguinal lymph nodes applied to lymphadenectomy in penile cancer

Identification of High Risk Pathological Node Positive Penile Carcinoma: Value of Preoperative Computerized Tomography Imaging

Patients with penile carcinoma, and 3 or more histopathologically proven unilateral metastatic inguinal nodes, and/or extranodal extension, and/or pelvic metastasis are considered a subgroup with prognostically unfavorable parameters for disease specific death and local recurrence after inguinal lymphadenectomy. We established radiographic criteria for the preoperative identification of such patients. Preoperative diagnostic computerized tomography studies of 30 patients with penile carcinoma with proven unilateral or bilateral lymph node metastasis were reviewed independently by 2 radiologists blinded for patient data. All computerized tomography images were analyzed per side (60). Several radiographic criteria were assessed for regional lymph nodes with short-axis diameter 8 mm or greater and/or central nodal necrosis. Sides were characterized as high risk if histopathology revealed 3 or more metastatic inguinal nodes and/or extranodal extension and/or pelvic nodal involvement. Histopathological nodal involvement was found in 38 sides (63%) including 22 sides (37%) defined as high risk. The presence of central nodal necrosis and/or irregular nodal border of the regional lymph nodes on the preoperative computerized tomography identified the high risk subgroup with a sensitivity of 95% (21 of 22) and a specificity of 82% (31 of 38). All 7 sides falsely designated as high risk harbored inguinal metastases but they were classified as low risk. The interobserver agreement of each radiographic parameter was almost perfect. The presence of central nodal necrosis and/or an irregular nodal border of the regional lymph nodes on preoperative computerized tomography images are accurate and reproducible criteria to identify high risk pathological node positive penile cancer. These criteria can be used for risk stratification and patient counseling.

Anatomic Aspects of Inguinal Lymph Nodes Applied to Lymphadenectomy in Penile Cancer

Objectives. To provide a better understanding of the distribution of inguinal nodes in order to prevent the complications of unnecessary and extended dissections in penile cancer. Methods. The bilateral inguinal regions of 19 male cadavers were dissected. Nodal distribution was noted and quantified based on anatomical location. The superficial nodes were subdivided into quarters as follows: superomedial, superolateral, inferomedial, and inferolateral. Statistical analysis was performed comparing node distribution between quarters using one-way analysis of variance (ANOVA), and the unpaired T-test was used between superficial and deep nodes. Results. Superficial nodes were found in all inguinal regions studied (mean = 13.60), and their distribution was more prominent in the superomedial quarter (mean = 3.94) and less in the inferolateral quarter (mean = 2.73). There was statistical significance between quarters when comparing the upper group with the lower one (P = 0.02). Nodes were widely distributed in the superficial region compared with deep lymph nodes (mean = 13.60 versus 1.71, P < 0.001). Conclusions. A great number of inguinal lymph nodes are distributed near the classical anatomical landmarks for inguinal lymphadenectomy, more prominent in upper quadrants.

Association Between Lymph Node Density and Disease Specific Survival in Patients With Penile Cancer

We assessed the value of lymph node density for predicting disease specific survival after lymphadenectomy for penile cancer. Data were collected retrospectively in 75 and prospectively in 88 consecutive patients with squamous cell carcinoma of the penis treated at M. D. Anderson Cancer Center between 1979 and 2007. We identified 45 patients with penile cancer and nodal metastasis who underwent lymphadenectomy with curative intent. Lymph node density was analyzed as a categorical variable by grouping patients into 2 or 3 categories based on equal percents. We explored the prognostic value of lymph node density for predicting disease specific survival in this cohort. Median followup was 23.7 months in all patients. By the time of analysis 22 patients had died, including 18 (82%) of penile cancer and 4 (18%) of other causes. Median lymph node density in patients alive or dead of other causes was 3.4% (IQR 2.9-5.9) compared to 43.3% (IQR 15.6-80) in those dead of disease (p <0.001). Median lymph node density in all patients was 6.7%. Estimated 5-year disease specific survival in patients with lymph node density 6.7% or less was significantly better than that in patients with lymph node density greater than 6.7% (91.2%, 95% CI 53.9-98.8 vs 23.3%, 95% CI 7.0-45.1, p <0.001). In models comparing lymph node density to known prognostic features lymph node density remained statistically significant, while the other factors were no longer statistically associated with disease specific survival. Lymph node density proved to be a significantly better prognosticator of disease specific survival than the current TNM nodal staging system in patients with penile cancer and nodal involvement. Further independent validation is required to determine the clinical usefulness of lymph node density in this patient population.

Primary skin closure of large groin defects after inguinal lymphadenectomy for penile cancer using an abdominal cutaneous advancement flap.

PURPOSE Large groin defects may be created after inguinal lymphadenectomy for bulky metastatic penile cancer. We describe a new method of primary closure of a large groin skin defect. MATERIALS AND METHODS In 3 patients with large volume inguinal lymph node metastases with skin breakdown and secondary infection extensive inguinal lymphadenectomy was done with wide surgical excision of skin and subcutaneous tissue. The procedures resulted in a large groin defect. Sartorius muscle was transferred to cover the femoral vessels. An abdominal advancement cutaneous flap was placed for soft tissue and skin coverage of the wound. RESULTS Primary closure of a large skin defect was possible using an abdominal advancement flap. In all patients the wound healed primarily with good cosmesis. A single patient underwent postoperative external beam radiation therapy to the flap site with no untoward effect on graft survival. CONCLUSIONS Large groin skin defects can be closed primarily using an abdominal advancement flap. This technique may also be used for bilateral groin defects. Compared with other types of flaps advocated for this purpose the main advantages of the procedure are simplicity, lower morbidity and superior cosmetic results.