Presentation Authors: Barrett McCormick*, Matthew Meissner, Houston, TX, Mounsif Azizi, Julio Slongo, Philippe Spiess, Tampa, FL, Curtis Pettaway, Houston, TX
Introduction: Penile Cancer guideline-based care for patients with invasive high risk primary tumors recommends the use of dynamic sentinel lymph node biopsy (DSNB) or superficial inguinal lymph node dissection (SILND) as inguinal staging tools. We present the first multi-institutional review of the use of SILND in the high-risk penile cancer patient.
Methods: A retrospective review was performed among patients treated at the University of Texas MD Anderson Cancer Center in Houston, Texas and the H. Lee Moffitt Cancer Center in Tampa, FL. High risk penile cancer was defined as pathologic stage â‰¥ T1b and with palpably negative inguinal exams who underwent open bilateral SILND. Subsequent to frozen section analysis, patients with microscopic metastases underwent ipsilateral completion inguinal (and in some cases pelvic) lymph node dissection. Complications were evaluated based on the Clavien-Dindo classification system.
Results: 82 patients were identified who met the inclusion criteria. The median age at presentation was 59.5 (26-83). Clinical and pathological characteristics are listed in Table 1. A total of 6 patients (7.3%) had positive nodes on SILND. At a median follow-up of 68 months (1-241), a total of 2 (2.6%) inguinal recurrences were noted, all in pN0 patients. An additional 3 patients (3.9%) developed distant metastatic disease. Surgical complications were appreciated in 33 (40.2%) patients and outlined in Table 2. 7.4% of patients had multiple complications. The most common complications were wound infection and lymphocele (18 patients, 22.2%). The were 12 (30%) Clavien grade III complications identified. Of the 6 patients with pN+ disease, 3 (50%) had complications.
Conclusions: SILND is an effective staging tool to identify patients harboring microscopic inguinal metastases from penile cancer with a low rate of false negative findings. Surgical morbidity is greater than for DSNB and further prospective studies comparing the two modalities are needed.