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18th Meeting of the EAU Section of Oncological Urology (ESOU21)

ESOU 2021: eUROGEN Lecture: Reducing Morbidity and Complications by Knowledge Sharing in Rare Tumors

(UroToday.com) At the European Association of Urology (EAU) Section of Oncological Urology (ESOU) 2021 Virtual Meeting, Dr. Vijay Sangar provided the eUROGEN lecture discussing reducing morbidity and complications by knowledge sharing in rare tumors. The eUROGEN group is the European Reference Network for Rare and Complex Urogenital Diseases and Conditions with members across several European Union countries.

Dr. Sangar highlights that the path to improving morbidity in rare cancers is through a tried and tested model of collective clinical governance, as well as time and dedication. For example, with regards to clinical audit and effectiveness, eUROGEN set the service benchmark for treating penile cancer at 40 new cases and 30 resections. Additionally, centers must have appropriately trained urologists, oncologists, pathologists, radiologists, specialist nurses, psychology coordinators/psycho-sexual services, plastic surgeons, and palliative care. The clinical quality indicators (based on clinical consensus) for penile cancer are as follows:

  • Sentinel node biopsy false-negative rate of <7%
  • Post inguinal node dissection emergency re-admission rate <10%
  • Number of dynamic sentinel node biopsy and inguinal lymph node dissection
  • Proportion of penile preserving surgery (partial glansectomy, circumcision, glansectomy, partial penectomy) over total resections >40%
In an eUROGEN survey of penile cancer surgeons utilization of dynamic sentinel lymph node biopsy and radical inguinal lymph node dissection recently published,1 they found that 57% of surgeons perform >10 inguinal lymph node dissections per year and 86% offer dynamic sentinel lymph node biopsy. However, there was variation in management with regards to dye injection site, use of lymphoscintigraphy, preferred incision sites, techniques for lymphatic control, duration of empiric antibiotic therapy, perioperative thromboprophylaxis, time points for drain removal, and definition of the inguinal lymph node dissection floor.


Dr. Sangar notes that it is important to re-standardize and manage risk with further consensus (rapid Delphi process), new standards, and clinical trials. Additionally, it is important to use/share information and learn, as well as utilize clinical panels and multi-disciplinary teams:

ESOU21_-_Sangar_-_Figure_1.png

eUROGEN has several platforms for professionals and patients, including Twitter (575 followers) and Instagram (185 followers), with 18,143 users and 53,515 page views:

ESOU21_-_Sangar_-_Figure_2.png

Presented by: Vijay Sangar, BSc, MBChB, MD, FCRS(Urol), Christie Hospital NHS Foundation Trust, Manchester, UK

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia Twitter: @zklaassen_md, during the 18th Meeting of the EAU Section of Oncological Urology (ESOU21), January 29-31, 2021

References: 

  1. Fankhauser CD, Ayres BE, Issa A, et al. Practice Patterns Among Penile Cancer Surgeons Performing Dynamic Sentinel Lymph Node Biopsy and Radical Inguinal Lymph Node Dissection in Men with Penile Cancer: A eUROGEN Survey. Eur Urol Open Sci 2021;24:39-42.