Surgical staging is recommended in intermediate to high risk clinically node negative (cN0) penile cancer (PeCa). Because (modified) inguinal lymph node dissection (ILND) is associated with high morbidity, dynamic sentinel node biopsy (DSNB) was introduced with the aim to reduce morbidity while maintaining diagnostic accuracy.
To determine the incidence and types of complications after DSNB and identify risk factors for the occurrence of postoperative complications.
We evaluated 644 PeCa patients (1284 DSNB procedures) with at least one cN0 groin who underwent DSNB between 2011 and 2020 at a single high-volume centre. 30-day and 30-90-day postoperative complications were collected according to the modified Clavien Dindo classification and the standardized methodology proposed by the European Association of Urology panel. Univariable and multivariable generalized linear mixed models were used to identify risk factors for the occurrence of complications per groin.
A 30-day postoperative complication occurred in 14% of groins (n=186), of which 94% were mild to moderate. Wound infection and lymphocele formation were most common. 30-90-day postoperative complications occurred in 3.4% of the groins, all of which were mild or moderate (grade 1-2). The number of removed LNs per groin was the main independent predictor for any 30-day complications and grade≥2 complications (OR 1.40; p<0.001). An increase in the probability of postoperative complications with the number of LNs removed was observed after accounting for all confounders.
Despite being less morbid than (modified) ILND, DSNB is still associated with a considerable risk of mild to moderate postoperative complications. This risk increases with an increasing number of LNs removed. Further procedural refinement aimed at removing the true sentinel node(s) only, may help further reduce the morbidity of surgical staging in PeCa.
BJU international. 2022 Mar 08 [Epub ahead of print]
Lieke Wever, Hielke M de Vries, Paolo Dell'Oglio, Henk G van der Poel, Maarten L Donswijk, Karolina Sikorska, Fijs W B van Leeuwen, Simon Horenblas, Oscar R Brouwer
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands., Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.