Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL.
Department of Urology, and Winship Cancer Institute, Emory University, Atlanta, GA.
Urol Oncol. 2021 Jul;39(7):439.e9-439.e15. doi: 10.1016/j.urolonc.2021.03.007. Epub 2021 Mar 26.
Inguinal lymph node (ILN) staging and therapeutic procedures are important for the diagnosis and management of suspected Inguinal lymph node metastasis in the setting of penile cancer. Morbidity associated with inguinal lymph node dissection (ILND) and the lack of standardization in its perioperative management are both significant. In this study, we aimed to define current management approaches and potential opportunities for improving outcomes.
A questionnaire was developed with 16 questions regarding pre, peri, and postoperative management of patients undergoing ILND. The questionnaire was approved by the Society of Urologic Oncology (SUO) Questionnaire Committee, which facilitated its dissemination through an initial email and a follow-up reminder to 1,003 members. The study was conducted from July to August, 2020.
Of the 1,003 SUO members invited to participate, 93 responded (9.3% response rate); 49% performed 1 to 2 ILNDs annually, and 60% chose open ILND for high-risk primary cancer cN0. For suspicious lymph nodes > 2 cm, 69% preferred ILND, 86% preoperative systemic neoadjuvant chemotherapy, followed by surgery for bulky inguinal metastasis, and 84% used perioperative antibiotics (ABX), 53% of whom discontinued ABX 24 hours after surgery. Prophylactic anticoagulation was used by 78% of respondents, and 60% stopped it after ambulation. Specific ligation of lymphatics (versus none) was used by 82% of respondents, 55% obtained frozen sections, and 94% used inguinal drains. A saphenous sparing technique was used by 75% of respondents. An incisional wound vacuum device was used by 17% of respondents. Compression stockings and/or referral to a lymphedema specialist were used to manage postoperative lymphedema by 61% of respondents.
Responses to a penile lymphadenectomy survey were relatively low and were primarily from the academic surgeon subset of the SUO. Significant consensus ( ≥ 70%) was noted for neoadjuvant chemotherapy for bulky nodal metastasis prior to surgery, perioperative antibiotic use, ligation of lymphatics, drain placement, and saphenous sparing dissection techniques. Other evidenced-based strategies that could decrease morbidity were rarely used, including dynamic sentinel node biopsy, incisional wound vacuums, and lymphedema prevention. Prospective trials are needed to validate and resolve existing treatment paradigms and to optimize perioperative pathways to reduce complications in penile cancer management.
腹股沟淋巴结（ILN）分期和治疗程序对于阴茎癌中可疑腹股沟淋巴结转移的诊断和管理非常重要。腹股沟淋巴结清扫术（ILND）相关的发病率以及其围手术期管理缺乏标准化都是显著的问题。在这项研究中，我们旨在确定当前的管理方法和改善结果的潜在机会。
我们制定了一份包含 16 个问题的问卷，内容涉及接受 ILND 的患者的术前、术中和术后管理。该问卷经泌尿肿瘤协会（SUO）问卷委员会批准，通过初始电子邮件和后续提醒向 1003 名成员进行了传播。研究于 2020 年 7 月至 8 月进行。
在受邀参加的 1003 名 SUO 成员中，有 93 名做出了回应（9.3%的回应率）；49%的人每年进行 1 到 2 次 ILND，60%的人选择开放式 ILND 用于高危原发性癌症 cN0。对于可疑的>2cm 淋巴结，69%的人首选 ILND，86%的人在手术前进行全身新辅助化疗，然后对大体积腹股沟转移灶进行手术，84%的人使用围手术期抗生素（ABX），其中 53%的人在手术后 24 小时停止使用 ABX。78%的受访者使用预防性抗凝治疗，60%的人在开始活动后停止抗凝治疗。82%的受访者使用了特定的淋巴管结扎（而非不结扎）技术，55%的人获取了冷冻切片，94%的人使用了腹股沟引流管。75%的受访者使用了隐静脉保留技术。17%的受访者使用了切口伤口负压装置。61%的受访者使用了压缩袜和/或转介给淋巴水肿专家来管理术后淋巴水肿。
对阴茎淋巴结清扫术的调查回应相对较低，主要来自 SUO 的学术外科医生亚组。在手术前对大体积淋巴结转移灶进行新辅助化疗、围手术期使用抗生素、结扎淋巴管、放置引流管和隐静脉保留解剖技术方面，达成了显著的共识（≥70%）。其他可能降低发病率的循证策略很少使用，包括动态前哨淋巴结活检、切口伤口负压装置和淋巴水肿预防。需要前瞻性试验来验证和解决现有的治疗模式，并优化围手术期途径，以减少阴茎癌管理中的并发症。
