Bakshi Ganesh K, Pal Mahendra, Jain Deep Kumar, Arora Amandeep, Tamhankar Ashwin, Maitre Priyamvada, Murthy Vedang, J Arunkumar, Agrawal Archi, Menon Santosh, Joshi Amit, Spiess Philippe E, Prakash Gagan J
Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Assistant Professor, MGM Medical College and Super-speciality Hospital, Indore, India.
Urol Oncol. 2023 Sep;41(9):393.e9-393.e16. doi: 10.1016/j.urolonc.2023.06.014. Epub 2023 Jul 26.
Modified and superficial inguinal lymph node dissection (MILD and SILD) are the 2 widely used templates for surgical staging of clinically node negative (cN0) penile cancer (PeCa); however, no previous reports have compared their outcomes. We compared these 2 surgical templates for oncological outcomes and complications.
We retrospectively reviewed records of cN0 PeCa patients who underwent MILD/SILD at our cancer care center from January 2013 to December 2019. Patients who developed a penile recurrence during follow up were excluded from analysis of oncological outcomes. The 2 groups (MILD and SILD) were compared for baseline clinico-pathological characteristics. The primary outcome was the groin recurrence free survival (gRFS). Secondary outcomes included the false negative rate (FNR) and disease free survival (DFS) for both templates and also the post-operative wound related complication.
Of the 146 patients with intermediate and high risk N0 PeCa, 74 (50.7%) and 72 (49.3%) underwent MILD and SILD respectively. The 2 groups were comparable with regards to the distribution of T stage, tumor grade and the proportion of intermediate and high-risk patients. At a median follow up of 34 months (47 for SILD and 23 for MILD), a total of 5 groin recurrences were encountered; all of them occurred in the MILD group. The gRFS and DFS for the MILD group was 93.2% and 91.8% respectively; while that for the SILD group was 100% and 94.4% respectively. Too few events had occurred to determine any statistically significant difference. The FNR for MILD and SILD was 26.3% and 0% respectively. The overall complication rate was significantly higher in the SILD group (46% vs 20.3%, p=0.001), especially for Clavien Dindo 3A complications.
MILD can fail to pick up micro-metastatic disease in a small proportion of cN0 PeCa patients, while SILD provides better oncological clearance with no groin recurrences. This oncological superiority comes at the cost of a higher incidence of wound-related complications.
改良腹股沟浅淋巴结清扫术（MILD）和浅表腹股沟淋巴结清扫术（SILD）是临床淋巴结阴性（cN0）阴茎癌（PeCa）手术分期中广泛使用的两种术式；然而，此前尚无报告比较它们的疗效。我们比较了这两种手术术式的肿瘤学结局和并发症情况。
我们回顾性分析了2013年1月至2019年12月期间在我们癌症治疗中心接受MILD/SILD的cN0 PeCa患者的记录。在随访期间出现阴茎复发的患者被排除在肿瘤学结局分析之外。比较两组（MILD组和SILD组）的基线临床病理特征。主要结局是腹股沟无复发生存期（gRFS）。次要结局包括两种术式的假阴性率（FNR）和无病生存期（DFS），以及术后伤口相关并发症。
146例中高危N0 PeCa患者中，74例（50.7%）和72例（49.3%）分别接受了MILD和SILD。两组在T分期分布、肿瘤分级以及中高危患者比例方面具有可比性。中位随访34个月（SILD组47个月，MILD组23个月），共发生5例腹股沟复发；均发生在MILD组。MILD组的gRFS和DFS分别为93.2%和91.8%；而SILD组分别为100%和94.4%。由于发生的事件太少，无法确定任何统计学上的显著差异。MILD和SILD的FNR分别为26.3%和0%。SILD组的总体并发症发生率显著更高（46%对20.3%，p = 0.001），尤其是Clavien Dindo 3A级并发症。
MILD在一小部分cN0 PeCa患者中可能无法检出微转移疾病，而SILD能提供更好的肿瘤学清除效果且无腹股沟复发。这种肿瘤学上的优势是以伤口相关并发症发生率较高为代价的。
