Incidence and risk factor analysis of complications after sentinel node biopsy for penile cancer

Abstract

L.W. and H.M.V. contributed equally. Patient summary: Early complications after DSNB were seen in 14% of groins and were predominantly minor complications. Most frequent complications were wound infection and lymphocele formation. The main risk factor was the number of removed lymph nodes. ObjectiveTo 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. Patients and MethodsWe 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. ResultsA 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. ConclusionsDespite 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.

Surgical complications following sentinel lymph node biopsy guided by γ‐probe and methylene blue in 113 tumour‐bearing dogs

“…This result is in accordance with a previous report in which an increased risk of postoperative complications of injection‐site sarcoma excision was found in cats with higher body weight 35 . In people, there are conflicting data regarding the impact of Body Mass Index (BMI) 32,46 . Furthermore, nutrition status in humans seems to have a negligible influence on early complications and to be mainly correlated with an increased risk of late postoperative complications 32,46 .…”

“…The number of excised SLN is a well‐known predictor of short‐term postoperative complications of lymphadenectomies in humans 32,46 . In the present study, we failed to demonstrate a similar correlation.…”

“…Surgical complications of SLNB were classified as intraoperative, if occurred during anaesthesia, and postoperative, when recorded after recovery from anaesthesia and within the first 90 days after surgery. Based on time of onset and resolution, postoperative complications of SLNB were classified in early (0–30 days postoperatively) and late (31–90 days postoperatively) 32,33 . Complications causing life‐threatening events, requiring surgical revision, or causing permanent impairment of normal activities and quality of life were deemed as major complications 34 .…”

“…In case of MCT, nodes with HN > 1 were considered metastatic. Concerning the multivariate variable models, the number of variables to be included was decided according to the event‐per‐variable (EPV) rule 32 . Since a maximum of three variables were allowed, weight, number of sentinel lymphocenters and number of SLN were included based on clinical significance.…”

“…Based on time of onset and resolution, postoperative complications of SLNB were classified in early (0-30 days postoperatively) and late (31-90 days postoperatively). 32,33 Complications causing lifethreatening events, requiring surgical revision, or causing permanent impairment of normal activities and quality of life were deemed as major complications. 34 Furthermore, surgical complications were retrospectively graded according to the VCOG-CTCAEv2 classification.…”