Penile Cancer: Contemporary Lymph Node Management

O’Brien, J; Perera, Marlon; Manning, Todd; Bozin, Mike; Cabarkapa, Sonja; Chen, Emily C; Lawrentschuk, Nathan

doi:10.1016/j.juro.2017.01.059

Cited by 51 publications

(40 citation statements)

References 49 publications

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“…In contrast to local recurrence patterns, regional recurrence (10.3%) and/ or distant metastasis (13.8%) were more frequent in those patients treated with partial or total penectomy, which is most likely due to the fact that patients who underwent (partial) penectomy had a higher primary tumor staging (≥ pT2: 44.8% vs. 11.5%) with increased positive inguinal lymph node status at primary invasive nodal staging (36.4% vs. 0%), thus being at higher risk for distant cancer spread on follow-up. Previous studies have shown that narrow surgical resection margins of only a few millimeters are sufficient to control local disease without affecting OS [39,40], so that penile-preserving surgery can spare a considerable amount of tissue [21,22] allowing a paradigm shift towards more organ-sparing approaches. Whichever surgical technique is chosen to manage the primary tumor lesion, lymph node management should be based on the recommended guidelines [5].…”

Section: Discussionmentioning

confidence: 99%

“…Whichever surgical technique is chosen to manage the primary tumor lesion, lymph node management should be based on the recommended guidelines [5]. Primary DSNB in patients with ≥ pT1G2 without palpable inguinal lymph nodes has matured into a reliable staging method with lower morbidity rates than rLND [5,38,39]. To ensure a good long-term oncological outcome with early detection of local recurrence, organ-preserving surgery needs a good patient compliance and should always be followed by careful patient management with regular physician and self-investigation, and regular oncological follow-up visits.…”

Section: Discussionmentioning

confidence: 99%

“…Histopathological staging of penile lesions showed pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. The most frequent tumor grade was grade 2 in 32 cases (58.2%), grade 3 in 12 [39]. In addition to early dynamic imaging (not displayed) following intradermal injection of 40 MBq Technetium-99 m-labelled nanocolloidal albumin (99mTc-Nanocoll ® ) peritumorally, planar static imaging 60 min post-injection of the pelvis is performed, including combined single-photon-emission tomography with low-dose computed tomography (SPECT/CT) acquisition.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

et al. 2019

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Purpose To report on the oncological outcome of organ-sparing surgery (OSS) compared to (total or partial) penectomy regarding recurrence patterns and survival in squamous cell carcinoma (SCC) of the penis. Methods This was a retrospective study of all patients with penile SCC and eligible follow-up data of at least 2 years at our institution. Patients with tumors staged ≥ pT1G2 underwent invasive lymph node (LN) staging by dynamic sentinel-node biopsy or modified inguinal lymphadenectomy. Radical inguinal lymphadenectomy was performed when LNs were palpable at diagnosis and in those with a positive LN status after invasive nodal staging. Follow-up visits were assessed, and local, regional and distant recurrences were defined and analyzed. Results 55 patients were identified with a mean follow-up of 63.7 months. Surgical management was OSS in 26 patients (47.2%) and partial or total penectomy in 29 cases (52.8%). Histopathological staging was: pTis (12.7%), pTa (16.3%), pT1a (18.2%), pT1b (5.5%), pT2 (29.1%) and pT3 (18.2%), respectively. Patients in the penectomy group were significantly older (mean 68 vs. 62 years; p = 0.026) with a higher rate of advanced tumor stage (≥ pT2: 44.8% vs. 11.5%; p = 0.002). The local recurrence rate was 42.3% (n = 11) following OSS compared to 10.3% (n = 3) after penectomy (p = 0.007). Kaplan-Meier curves showed no significant differences between the two groups regarding metastasis-free and overall survival. Conclusions OSS is associated with a higher local recurrence rate compared to penectomy, yet it has no negative impact on overall and metastasis-free survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 99%

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Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

et al. 2019

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“…The geographical flexibility provided by residents who are spread over regions allows access to a wide range of different practices which can increase the generalisability of the results and provide large samples sizes that are powered to investigate associations and disease areas that may otherwise be difficult to. Types of research projects that work well within resident-led collaboratives are observational cohort studies [1,2], case-control studies [3], systematic reviews [4][5][6], meta-analysis [7], and randomised controlled trials [8][9][10].…”

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confidence: 99%

Safeguarding the Future of Urological Research and Delivery of Clinical Excellence by Harnessing the Power of Youth to Spearhead Urological Research

et al. 2018

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Trainee-led collaboratives offer exciting new perspectives and approaches to urological research. They provide a central network of expertise in methodology, mentoring, and knowledge of research processes that allows the conduct of large multicentre studies that can recruit quickly. This provides the consultant workforce of tomorrow with the skills required to deliver practice-changing clinical studies in urology.

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“…It has also incorporated the development of, and is freely available to, medical students. Providing an avenue for ease of access to contributions in current projects, in addition to a communication nexus where questions are answered and advice is given by senior researchers who have experience within the field of Urology research.Despite its infancy, early successes can be seen in YURO's involvement in several publications [3][4][5]. In addition to regular education sessions with medical students and perhaps most importantly, an ongoing dialogue between junior members interested in improving their research methods and experienced members interested in sharing their wisdom.…”

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confidence: 99%

“Collaboration Through Communication”: The Young Urology Researchers Organisation (YURO)

et al. 2016

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In an ideal world, research to investigate the effects of a phenomenon would be measured on a population scale. The benefits of open access and lateral sharing of resources, data and staff across clinical centres are extensive. Unfortunately, logistics often limit study sample sizes to single centre cohorts whose findings may be influenced by confounding factors and are not translatable to the wider community. To combat this, multi-centre trials have been endorsed to upscale the statistical power and significance of scientific research findings to benefit patients and clinicians alike. Large-scale multicentre trials such as STAMPEDE [1] are clear examples of how findings of relationships of causality are strengthened through larger sample sizes. Such studies are often birthed through significant financial support and networks that senior clinicians built through years of practice, or by large well funded trials groups such as the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group.Certainly, younger and more inexperienced researchers seldom get the chance to contribute to the existing large-scale collaboration projects and few structured avenues are available to advise and support those who are new to healthcare research. Juniors and trainees have found it difficult to acquire the requisite skills to produce high quality work and it is often presumed sometimes incorrectly, that with time and career development, these skills will be cultivated without the aid of a formal body to do so.With the recent advent of social media and communication technologies, the ability of professionals to network and communicate has never been greater. Further to this, involvement of senior clinicians in these forums and online dialogue allows for teaching and review of junior researchers and trainees. It is this innovative style of interaction and cooperation that has led to the formation of several groups driven by young researchers, guided by senior clinicians, that have the aim of producing high-quality research through collaborative efforts.The Young Urology Researchers Organisation (YURO) is one such organization, formed by a select few likeminded people, with the intention of contributing to the wider academic community of Australian urological research. The group was legitimized in 2016 with its first annual assembly at the Urological Society of Australia and New Zealand's annual scientific meeting. Run exclusively by its members, the organization aims to increase the validity of its research efforts by combining data and findings across multiple institutions. Currently, representatives from over 9 clinical sites including rural Victoria and New Zealand are involved, with plans to expand into other states. Members communicate via several avenues including formal committee meetings, a website [2] an online project log available to all members and a centralized email account. This open online forum affords members the ability to bounce project ideas off one another, review fellow colleague's work and...

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Penile Cancer: Contemporary Lymph Node Management

Cited by 51 publications

References 49 publications

Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

Organ-sparing surgery of penile cancer: higher rate of local recurrence yet no impact on overall survival

Safeguarding the Future of Urological Research and Delivery of Clinical Excellence by Harnessing the Power of Youth to Spearhead Urological Research

“Collaboration Through Communication”: The Young Urology Researchers Organisation (YURO)

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