BERKELEY, CA (UroToday.com) - The main objective of our study was to evaluate if our rates of complications of lymphadenectomy in cancer of the penis would change after years of using the Gibson incision. Our 1991 study, often cited in the literature, compared various types of incisions and showed a lower complication rate with the Gibson incision.
From 1972 to 1987, 200 consecutive lymphadenectomies were performed in 112 patients with squamous cell carcinoma of the penis. The Gibson incision had a low morbidity rate (5% flap necrosis, 15% wound infection, 16% lymphedema, and 9% lymphocele). These data were often not cited, since articles published on this topic later considered our complication rate in a sum of complication rates of all incisions performed at this time. In this new study, bilateral inguinal lymphadenectomies were performed in 170 patients, totaling 340 procedures, using only Gibson incision. Prophylactic and therapeutic radical inguinal lymphadenectomies were performed in 67 (39.4%) and 103 (60.6%) patients, respectively. A total of 35 (10.3%) complications were observed; of these, 25 (71.4%) were minor and 10 (28.6%) major complications. Lymphedema occurred in 14 (4.1%) patients, seroma in 4 (1.2%), scrotal edema in 3 (0.9%), skin edge necrosis in 3 (0.9%), lymphoceles in 3 (0.9%), wound infection in 2 (0.6%), flap necrosis in 2 (0.6%), wound abscess in 2 (0.6%), and deep venous thrombosis in 2 (0.6%) patients. There was no significant difference in the complication rates between patients undergoing prophylactic dissection and those undergoing therapeutic dissection. The mean length of hospital stay was 6.4 days (range 4 to 27) and the average time for performing radical unilateral inguinal lymphadenectomy was 94 minutes.
Our contemporary series presents the lower incidence of complications such as: wound infection, skin flap necrosis, lymphocele, and lymphedema. As can be seen in the following table from our article, this series presents the lowest incidence rate of complications described in the international literature.
|
Study |
Year |
# of Pts |
Overall complication rate (%) |
Wound infection (%) |
Wound dehiscence + necrosis (%) |
Lymphocele (%) |
Lymphedema (%) |
|
|
Johnson et al.[5] |
1984 |
67 |
82 |
14 |
50 |
9 |
50 |
|
|
Ornellas et al. [4] * |
1991 |
44 |
– |
15 |
5 |
9 |
16 |
|
|
Ravi [6] |
1993 |
112 |
– |
– |
25 |
9 |
16 |
|
|
Kamat et al. [7] |
1993 |
31 |
87 |
– |
– |
– |
– |
|
|
Lopes et al [8] |
1996 |
145 |
– |
– |
18 |
– |
30 |
|
|
Darai et al. [9] |
1988 |
85 |
– |
12 |
14 |
3 |
32 (severe) |
|
|
Ayyappan et al. [10] |
1994 |
78 |
– |
70 |
36 |
87 |
57 (severe) |
|
|
Coblentz et al. [11] |
2002 |
22 |
45 |
9 |
9 |
27.2 |
0 |
|
|
Bevan-Thomas et al [1] |
2002 |
53 |
57 |
10 |
8 (necrosis) |
– |
23 |
|
|
Nelson et al. [2] |
2004 |
22 |
– |
7.5 (minor) |
2.5 (necrosis) |
15 |
15 |
|
|
Spiess et al. [3] |
2008 |
43 |
49 |
9 |
11 |
2 |
17 |
|
|
Present Series |
2012 |
170 |
10.3 |
0.9 |
1.5 (necrosis) |
2 |
4.1 |
|
# number, Pts patients
*Gibson Incision
References:
- Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol. 2002;167:1638-42.
- Nelson BA, Cookson MS, Smith JA Jr, Chang SS. Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol. 2004;172:494-7.
- Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol. 2009;27:205-12.
- Ornellas AA, Seixas, AL, de Moraes JR. Analyses of 200 lymphadenectomies in patients with penile carcinoma. J. Urol. 1991; 146: 330-2.
- Johnson DE, Lo RK. Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology 1984;24:312–4
- Ravi, R. Morbidity following groin dissection for penile carcinoma. Br J Urol 1993;72: 941.
- Kamat MR, Kulkarni JN, Tongaonkar HB. Carcinoma of the penis: the Indian experience. J Surg Oncol 1993;52:50–5.
- Lopes A, Hidalgo GS, Kowalski LP, Torlani H, Rossi BM, Fonseca FP. Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol 1996;156:1637–42.
- Darai E, Karaitianos I, Durand JC. Treatment of inguinal lymph nodes in cancer of the penis. Apropos of 85 cases treated at the Institute Curie. Ann Chir 1988;42:748-52.
- Ayyappan K, Ananthakrishnan N, Sankaran V. Can regional lymph node involvement be predicted in patients with carcinoma of the penis? Br J Urol 1994;73:549–53,
- Coblentz TR, Theodorescu D. Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis. J Urol 2002;168:1386–9.
Written by:
Antonio Augusto Ornellas MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, Brazilian National Cancer Institute and Mário Kröeff Hospital, Rio de Janeiro, 20230-130, Brazil
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