Tag Archive for: inguinal lymph node dissection

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Article of the Week: Predicting Post-operative Complications of ILND for Penile Cancer

Every Week the Editor-in-Chief selects an Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video from Dr. Philippe Spiess, discussing his accompanying editorial to the Article of the Week. 

If you only have time to read one article this week, it should be this one.

Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort

Jared M. Gopman, Rosa S. Djajadiningrat*, Adam S. Baumgarten, Patrick N. EspirituSimon Horenblas*, Yao Zhu, Chris Protzel , Julio M. Pow-Sang*, Timothy Kim, Wade J. Sexton, Michael A. Poch and Philippe E. Spiess

 

Department of Genitourinary Oncology, Moftt Cancer Center, Tampa, FL, USA, *Department of Urological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands, Department of Urological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China, and Department of Urology, University of Rostock, Rostock, Germany

 

OBJECTIVES

To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications.

MATERIALS AND METHODS

A retrospective chart review was conducted across four international cancer centres. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien–Dindo classification system was used to standardize the reporting of complications.

RESULTS

A total of 181 patients (55.4%) had a postoperative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The American Joint Committee on Cancer stage was an independent predictor of all wound infections, while the patient’s age, ILND with Sartorius flap transposition, and surgery performed before the year 2008 were independent predictors of major wound infections.

CONCLUSIONS

This is the largest report of complication rates after ILND for squamous cell carcinoma of the penis and it shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased postoperative morbidity.

Editorial: Prediction and Predicament – Complications after ILND for Penile cancer

In the current issue of BJUI, Gopman et al. [1] report the findings of an international multicentre study examining postoperative complications after inguinal lymph node dissection (ILND) for penile cancer. Their study is the largest to date, and despite its retrospective nature, provides detailed insight into this complex and morbid procedure.

ILND is a critical step in penile cancer treatment, and according to the guidelines of the European Association of Urology, is warranted when the clinical suspicion of lymph node invasion arises [2]. ILND helps to refine pathological staging and has been incorporated into prognostic tools estimating cancer-specific survival after treatment [3]. Despite clinical necessity, ILND is associated with exceptionally high complication rates, as reflected by the current studies’ 55.4% postoperative complication rate. As expected, most of the complications were due to wound complications. Although the authors recognised a decrease in major wound infections after 2008, the overall rate of morbidity after ILND for penile cancer has not changed substantially when compared with historical series [4].

The process of care for these patients can be long and tedious; it affects the personal well-being of the patient and is also responsible for a heavy societal financial burden [5]. The results of the current retrospective analysis are particularly sobering, given that the current data are exclusively from centres specialising in the care of patients with penile cancer. The number of unreported complications at lower volume centres may well be much higher than those evidenced by Gopman et al. [1].

So what can we do to improve our surgical results? The study by Gopman et al. [1] provides us with some tools for advancement. They found that the numbers of removed lymph nodes was a predictor for overall complications in their cohort. Specifically, higher pathological stages were accountable for all wound infections, while age and sartorius flap transposition affected major wound infections significantly. Unfortunately, the study could not provide granular information on preoperative comorbidities, e.g. diabetes mellitus, chronic steroid use and smoking status among others, which could have offered a deeper understanding of the determinants of complication.

Nonetheless, the authors are to be commended for their efforts to provide the urological community with the best available evidence, collected thus far, about complications of ILND for penile cancer. The rarity of penile cancer may limit a clinician’s ability to perceive the early warning signs of a deviation from the routine postoperative course. As such, the current study will not only help us to better counsel our patients but may also help raise our postoperative awareness of complications, thereby achieving improvements in operative outcomes.

Christian P. Meyer*, Julian Hanske*‡ and Jesse D. Sammon*§

 

*Center for Surgery and Public Health, Brigham and WomenHospital, Harvard Medical School, Boston, MA, USA, Department of Urology, University Hospital Hamburg- Eppendorf, Hamburg, Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany and §VUI Center for Outcomes Research Ana lytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA

 

References

 

2 Hakenberg OW, Comperat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol 2014; 67: 142– 50

 

 

4 Ravi R. Morbidity following groin dissection for penile carcinoma. Br Urol 1993; 72: 9415

 

5 Drew P, Posnett J, Rusling L, Wound Care Audit Team. The cost of wound care for a local population in England. Int Wound J 2007; 4: 14955

 

Video: Predicting postoperative complications of ILND for penile cancer

Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort

Jared M. Gopman, Rosa S. Djajadiningrat*, Adam S. Baumgarten, Patrick N. EspirituSimon Horenblas*, Yao Zhu, Chris Protzel , Julio M. Pow-Sang*, Timothy Kim, Wade J. Sexton, Michael A. Poch and Philippe E. Spiess

 

Department of Genitourinary Oncology, Moftt Cancer Center, Tampa, FL, USA, *Department of Urological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands, Department of Urological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China, and Department of Urology, University of Rostock, Rostock, Germany

 

OBJECTIVES

To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications.

MATERIALS AND METHODS

A retrospective chart review was conducted across four international cancer centres. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien–Dindo classification system was used to standardize the reporting of complications.

RESULTS

A total of 181 patients (55.4%) had a postoperative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The American Joint Committee on Cancer stage was an independent predictor of all wound infections, while the patient’s age, ILND with Sartorius flap transposition, and surgery performed before the year 2008 were independent predictors of major wound infections.

CONCLUSIONS

This is the largest report of complication rates after ILND for squamous cell carcinoma of the penis and it shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased postoperative morbidity.

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