Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
BJU Int. 2022 Oct;130(4):486-495. doi: 10.1111/bju.15725. Epub 2022 Mar 17.
To determine the incidence and types of complications after dynamic sentinel node biopsy (DSNB) in patients with penile cancer (PeCa) and identify risk factors for the occurrence of postoperative complications.
We evaluated 644 patients with PeCa (1284 DSNB procedures) with at least one clinically node negative (cN0) groin who underwent DSNB between 2011 and 2020 at a single high-volume centre. The 30- and 30-90-day postoperative complications were collected according to the modified Clavien-Dindo classification and the standardised methodology proposed by the European Association of Urology panel. Uni- and multivariable generalised 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. A 30-90-day postoperative complication occurred in 3.4% of the groins, all of which were mild or moderate (Grade I-II). The number of removed lymph nodes (LNs) per groin was the main independent predictor for any 30-day complications and Grade ≥II complications (odds ratio 1.40; P < 0.001). There was an increase in the probability of postoperative complications with the number of LNs removed after accounting for all confounders.
Despite being less morbid than (modified) inguinal LN dissection, DSNB is still associated with a considerable risk of postoperative mild-to-moderate complications. This risk increases with 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.
确定阴茎癌（PeCa）患者行动态前哨淋巴结活检（DSNB）后的并发症发生率和类型，并确定术后并发症发生的危险因素。
我们评估了 2011 年至 2020 年间在一家高容量中心接受 DSNB 的 644 例至少有一个临床淋巴结阴性（cN0）腹股沟的 PeCa 患者（1284 例 DSNB 手术）。根据改良的 Clavien-Dindo 分类和欧洲泌尿外科学会小组提出的标准化方法，收集 30 天和 30-90 天术后并发症。使用单变量和多变量广义线性混合模型来确定每个腹股沟发生并发症的危险因素。
30 天术后并发症发生在 14%的腹股沟（n = 186），其中 94%为轻度至中度。伤口感染和淋巴囊肿形成最常见。30-90 天术后并发症发生在 3.4%的腹股沟，均为轻度或中度（I-II 级）。每个腹股沟切除的淋巴结（LNs）数量是任何 30 天并发症和≥II 级并发症的主要独立预测因素（优势比 1.40；P < 0.001）。在考虑所有混杂因素后，随着切除的 LNs 数量增加，术后并发症的发生概率增加。
尽管 DSNB 比（改良）腹股沟淋巴结清扫术的发病率低，但仍与术后轻度至中度并发症的发生风险相当。这种风险随着切除的 LNs 数量的增加而增加。进一步改进手术方法，旨在仅切除真正的前哨淋巴结，可能有助于进一步降低 PeCa 手术分期的发病率。
