Lau Weida, Lim Isis Claire Z Y, Wong Joseph Cai Sheng, Ali Syed Zama, Kannivelu Anbalagan, Lee Jasmine Chan Bing, Eng Molly May Ping, Eardley Ian
Department of Urology, Khoo Teck Puat Hospital, Singapore, Singapore.
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore.
Transl Androl Urol. 2024 Jul 31;13(7):1268-1277. doi: 10.21037/tau-23-681. Epub 2024 Jul 16.
Lymph node status is a key prognostic factor in penile cancer. The European Association of Urology (EAU) recommends intermediate-risk (pT1a, Grade 2) or high-risk (pT1b or greater) penile cancer patients with clinically non-palpable inguinal lymph node (cN0) to undergo either an invasive bilateral modified inguinal lymph node dissection (ILND) or dynamic sentinel node biopsy (DSNB). DSNB has been reported to have acceptable false negative rates, and lower rates of long-term morbidity compared to ILND. We developed a protocol for DSNB at a regional hospital in Singapore that was adopted from St James's University Hospital, Leeds Teaching Hospitals Trust. Four patients with cN0 penile cancer underwent DSNB between November 2021 and October 2022 according to this protocol. Our surgical technique and protocol are described. The patients' oncological characteristics and their outcomes were evaluated. In this small case series, there was no complication attributable to the performance of DSNB, and there was no groin that was documented to be false negative over a median follow up of 15.5 months (range, 12 to 22 months). Using our protocol, 5 of 8 groins (62.5%) were able to avoid ILND in the cN0 setting. We recommend the adoption of DSNB for the surgical staging of inguinal lymph nodes for patients with intermediate to high-risk penile cancer and non-palpable inguinal nodes due to its significantly lower risks of long-term morbidity compared to ILND. Appropriate specialist training and a multi-disciplinary team is vital to ensure the success of the procedure.
淋巴结状态是阴茎癌的关键预后因素。欧洲泌尿外科学会（EAU）建议，对于临床触诊不可触及腹股沟淋巴结（cN0）的中危（pT1a，2级）或高危（pT1b及以上）阴茎癌患者，应进行侵入性双侧改良腹股沟淋巴结清扫术（ILND）或动态前哨淋巴结活检（DSNB）。据报道，与ILND相比，DSNB的假阴性率可接受，且长期发病率较低。我们在新加坡一家地区医院制定了一项DSNB方案，该方案借鉴了利兹教学医院信托基金圣詹姆斯大学医院的方案。根据该方案，2021年11月至2022年10月期间，4例cN0阴茎癌患者接受了DSNB。我们描述了手术技术和方案。评估了患者的肿瘤学特征及其预后。在这个小病例系列中，没有并发症可归因于DSNB的实施，在中位随访15.5个月（范围12至22个月）期间，没有腹股沟被记录为假阴性。使用我们的方案，在cN0情况下，8个腹股沟中有5个（62.5%）能够避免进行ILND。我们建议，对于中高危阴茎癌且腹股沟淋巴结不可触及的患者，采用DSNB进行腹股沟淋巴结的手术分期，因为与ILND相比，其长期发病率风险显著更低。适当的专科培训和多学科团队对于确保手术成功至关重要。
