Urologists' adherence to European Association of Urology and National Comprehensive Cancer Network guideline recommendations to perform inguinal (ILND) and pelvic (PLND) lymph node dissection in penile cancer (PC) patients is not known.
To assess a German-speaking European cohort of urologists based on their criteria to perform ILND and PLND in PC patients.
A 14-item survey addressing general issues of PC treatment was developed and sent to 45 clinical centers in Germany (n = 34), Austria (n = 8), Switzerland (n = 2), and Italy (n = 1).
Two of the 14 questions assessed the criteria to perform ILND and ipsilateral PLND.
Correct responses for ILND and PLND criteria were assessed. Based on a multivariate logistic-regression-model, criteria independently predicting guideline adherence were identified.
In total, 557 urologists participated in the survey, of whom 43.5%, 19.3%, and 37.2% were residents in training, certified, and in leading positions, respectively. ILND and PLND criteria were correctly identified by 35.2% and 23.9%, respectively. Of the participants, 23.3% used external sources for survey completion. The use of auxiliary tools (odds ratio [OR] 1.57; p[bootstrapped] = 0.028) and participants outside of Germany (OR 0.56; p[bootstrapped] = 0.006) were predictors of ILND guideline adherence. The number of PC patients treated yearly (p = 0.012; OR 1.06) and the use of auxiliary tools (p < 0.001; OR 5.88) were predictors of PLND adherence. Department size, healthcare status, professional status, and responsibility for PC surgery did not predict endpoints. Limitations include sample size and results in comparison with retrospective studies.
Our results demonstrate overall suboptimal knowledge of the correct indications to perform ILND and PLND in PC patients among the surveyed urologists. We propose that governments and healthcare providers should be encouraged to centralize PC management.
The management of inguinal and pelvic lymph nodes is crucial for the survival of penile cancer patients. Disease rarity mandates referral to clinical practice guidelines for appropriate treatment selection.
European urology focus. 2020 Feb 20 [Epub ahead of print]
Rodrigo Suarez-Ibarrola, Friedemann Zengerling, Marlene Haccius, Steffen Lebentrau, Hans-Peter Schmid, Maximilian Bier, Sebastian Lenart, Florian A Distler, Irene Resch, Markus Oelschlager, Matthias May, Christian Bolenz, Christian Gratzke, Arkadiusz Miernik, Gamal Anton Wakileh
Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany. Electronic address: ., Department of Urology, Ulm University Hospital, Ulm, Germany., Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany., Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany., Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland., Department of Urology, Bethel Evangelical Hospital, Bielefeld, Germany., Department of Urology, Paracelsus Medical University, Salzburg, Austria; Department of Urology, St. John of God Hospital Vienna, Vienna, Austria., Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology and Pediatric Urology, Würzburg University Hospital, Würzburg, Germany., Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/32089496