Kumar P, Singh S, Goddard J C, Terry T R, Summerton D J
Barts and The London NHS Trust, UK.
Ann R Coll Surg Engl. 2012 Apr;94(3):204-9. doi: 10.1308/003588412X13171221501906.
Although its incidence is increasing, penile cancer remains a rare disease in the UK. In view of this low volume, the National Institute for Clinical Excellence recommended that treatment is centralised in a limited number of centres arranged as supraregional networks. The aim of this centralisation is to allow the best standardised treatment for the primary tumours and nodal disease, thereby avoiding under or overtreatment. In this paper we review the formation and functioning of our network in the East Midlands.
Data were collected up to August 2010 from our prospective penile network database since its inception in 2005. These data were analysed to see our workload, patterns of referral and surgeries performed over this time period.
The structure and function of the East Midlands network are described. There has been an increase in the number of cases discussed since its formation. There has also been a trend towards more conservative surgery, both of the primary tumour and of nodal management. Between September 2009 and August 2010, 16 glansectomies were performed versus 5 total and 9 partial penectomies. The same period saw 18 dynamic sentinel lymph node biopsies against 7 bilateral and 3 unilateral superficial groin dissections. There was a very high patient satisfaction rate, with patients feeling they had good support and information.
On reviewing the literature it can be clearly seen that supraregional networks have led to a decrease in overtreatment and better recognition of the need to manage lymph node status optimally. Our network has demonstrated the trend toward conservative surgery and sentinel node biopsy. The formation of supraregional networks with a multidisciplinary approach will facilitate high volume centres that will offer optimal surgical therapy and also allow recruitment into studies and new chemotherapeutic regimens. It will also allow better data collection to aid clinical studies that hopefully will also demonstrate better outcomes.
尽管阴茎癌的发病率在上升，但在英国它仍然是一种罕见疾病。鉴于病例数量较少，英国国家卫生与临床优化研究所建议将治疗集中在少数几个作为区域以上网络安排的中心。这种集中化的目的是为原发性肿瘤和淋巴结疾病提供最佳的标准化治疗，从而避免治疗不足或过度治疗。在本文中，我们回顾了我们在东米德兰兹地区的网络的形成和运作情况。
自2005年我们的前瞻性阴茎网络数据库建立以来，收集了截至2010年8月的数据。对这些数据进行分析，以了解我们在这段时间内的工作量、转诊模式和实施的手术情况。
描述了东米德兰兹地区网络的结构和功能。自其形成以来，讨论的病例数量有所增加。在原发性肿瘤和淋巴结管理方面，也有一种采用更保守手术的趋势。在2009年9月至2010年8月期间，进行了16例龟头切除术，而全阴茎切除术为5例，部分阴茎切除术为9例。同期进行了18例动态前哨淋巴结活检，而双侧腹股沟浅淋巴结清扫术为7例，单侧腹股沟浅淋巴结清扫术为3例。患者满意度非常高，患者感觉他们得到了很好的支持和信息。
回顾文献可以清楚地看到，区域以上网络导致了过度治疗的减少，并更好地认识到优化管理淋巴结状态的必要性。我们的网络已显示出采用保守手术和前哨淋巴结活检的趋势。采用多学科方法形成区域以上网络将促进提供最佳手术治疗的大容量中心的发展，也将允许招募患者参加研究和新的化疗方案。这还将使更好的数据收集成为可能，以辅助临床研究，有望也能证明更好的治疗结果。
