Feasibility, complications and oncologic results of a limited inguinal lymph node dissection in the management of penile cancer
Identifieur interne : 001D87 ( Main/Merge ); précédent : 001D86; suivant : 001D88Feasibility, complications and oncologic results of a limited inguinal lymph node dissection in the management of penile cancer
Auteurs : Igor Tsaur [Allemagne] ; Carmen Biegel [Allemagne] ; Kilian Gust [Allemagne] ; Tanja Huesch [Allemagne] ; Hendrik Borgmann [Allemagne] ; Maximilian P. J. K. Brandt [Allemagne] ; Martin Kurosch [Allemagne] ; Michael Reiter [Allemagne] ; Georg Bartsch [Allemagne] ; David Schilling [Allemagne] ; Axel Haferkamp [Allemagne]Source :
- International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology [ 1677-5538 ] ; 2015.
Abstract
In patients with penile cancer (PeCa) and increased risk of inguinal lymphatic dissemination, inguinal lymphadenectomy offers a direct histological staging as the most reliable tool for assessment of the nodal metastasic status and a definitive oncologic treatment simultaneously. However, peri- and/or postoperative mutilating sequalae often occurn. We report on clinical outcome and complications of a limited inguinal lymph node (LN) dissection.
Clinical and histopathological data of all patients with PeCa who underwent limited inguinal lymphadenectomy (LIL) at our institution between 1986 and 2012 were comprehensively analyzed. Perioperative results were presented in relation to one-sided procedures, if appropriate, which were assessed without cross comparison with contralateral LILs.
29 consecutive patients with PeCa aged 60±10.3 years were included in the current study with 57 one-sided LIL performed. Mean operative time for one-sided LIL was 89.0±37.3 minutes with 8.1±3.7 LNs removed. A complication rate of 54.4% (n=31), including 16 minor and 15 major complications was found in a total of 57 procedures with leg oedema being the most prevalent morbidity (15.8%). 4 patients with clinically positive LNs developed inguinal lymphatic recurrence within 9 months after surgery.
Our technique of limited inguinal LN dissection provided an acceptable complication rate without aggravating morbidity. We experienced no recurrences in clinically LN negative patients, so that the approach might be a reasonable option in this scenario. In patients with enlarged LNs, radical inguinal lymphadenectomy still appears to represent the gold standard.
Url:
DOI: 10.1590/S1677-5538.IBJU.2014.0304
PubMed: 26200541
PubMed Central: 4752141
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type="main">Feasibility, complications and oncologic results of a limited inguinal lymph node dissection in the management of penile cancer</title><author><name sortKey="Tsaur, Igor" sort="Tsaur, Igor" uniqKey="Tsaur I" first="Igor" last="Tsaur">Igor Tsaur</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Biegel, Carmen" sort="Biegel, Carmen" uniqKey="Biegel C" first="Carmen" last="Biegel">Carmen Biegel</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Gust, Kilian" sort="Gust, Kilian" uniqKey="Gust K" first="Kilian" last="Gust">Kilian Gust</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Huesch, Tanja" sort="Huesch, Tanja" uniqKey="Huesch T" first="Tanja" last="Huesch">Tanja Huesch</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Borgmann, Hendrik" sort="Borgmann, Hendrik" uniqKey="Borgmann H" first="Hendrik" last="Borgmann">Hendrik Borgmann</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Brandt, Maximilian P J K" sort="Brandt, Maximilian P J K" uniqKey="Brandt M" first="Maximilian P. J. K." last="Brandt">Maximilian P. J. K. Brandt</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Kurosch, Martin" sort="Kurosch, Martin" uniqKey="Kurosch M" first="Martin" last="Kurosch">Martin Kurosch</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Reiter, Michael" sort="Reiter, Michael" uniqKey="Reiter M" first="Michael" last="Reiter">Michael Reiter</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Bartsch, Georg" sort="Bartsch, Georg" uniqKey="Bartsch G" first="Georg" last="Bartsch">Georg Bartsch</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Schilling, David" sort="Schilling, David" uniqKey="Schilling D" first="David" last="Schilling">David Schilling</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Haferkamp, Axel" sort="Haferkamp, Axel" uniqKey="Haferkamp A" first="Axel" last="Haferkamp">Axel Haferkamp</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author></analytic><series><title level="j">International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology</title><idno type="ISSN">1677-5538</idno><idno type="eISSN">1677-6119</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><sec><title>Purpose:</title><p>In patients with penile cancer (PeCa) and increased risk of inguinal lymphatic dissemination, inguinal lymphadenectomy offers a direct histological staging as the most reliable tool for assessment of the nodal metastasic status and a definitive oncologic treatment simultaneously. However, peri- and/or postoperative mutilating sequalae often occurn. We report on clinical outcome and complications of a limited inguinal lymph node (LN) dissection.</p></sec><sec><title>Materials and Methods:</title><p>Clinical and histopathological data of all patients with PeCa who underwent limited inguinal lymphadenectomy (LIL) at our institution between 1986 and 2012 were comprehensively analyzed. Perioperative results were presented in relation to one-sided procedures, if appropriate, which were assessed without cross comparison with contralateral LILs.</p></sec><sec><title>Results:</title><p>29 consecutive patients with PeCa aged 60±10.3 years were included in the current study with 57 one-sided LIL performed. Mean operative time for one-sided LIL was 89.0±37.3 minutes with 8.1±3.7 LNs removed. A complication rate of 54.4% (n=31), including 16 minor and 15 major complications was found in a total of 57 procedures with leg oedema being the most prevalent morbidity (15.8%). 4 patients with clinically positive LNs developed inguinal lymphatic recurrence within 9 months after surgery.</p></sec><sec><title>Conclusions:</title><p>Our technique of limited inguinal LN dissection provided an acceptable complication rate without aggravating morbidity. We experienced no recurrences in clinically LN negative patients, so that the approach might be a reasonable option in this scenario. In patients with enlarged LNs, radical inguinal lymphadenectomy still appears to represent the gold standard.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Protzel, C" uniqKey="Protzel C">C Protzel</name></author><author><name sortKey="Alcaraz, A" uniqKey="Alcaraz A">A Alcaraz</name></author><author><name sortKey="Horenblas, S" uniqKey="Horenblas S">S Horenblas</name></author><author><name sortKey="Pizzocaro, G" uniqKey="Pizzocaro G">G Pizzocaro</name></author><author><name sortKey="Zlotta, A" uniqKey="Zlotta A">A Zlotta</name></author><author><name sortKey="Hakenberg, Ow" uniqKey="Hakenberg O">OW Hakenberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Naumann, Cm" uniqKey="Naumann C">CM Naumann</name></author><author><name sortKey="Filippow, N" 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