Penile CancerEarly Wound Complications After Inguinal Lymphadenectomy in Penile Cancer: A Historical Cohort Study and Risk-factor Analysis
Introduction
Inguinal lymph node dissection (ILND) is performed in penile cancer patients at high risk for lymph node metastases or in patients with established regional lymph node metastases. ILND can also be performed after a tumour-positive sentinel node procedure or following tumour-positive fine needle aspiration cytology. ILND is carried out simultaneously with the removal of the primary tumour or as an elective procedure. In cases of pelvic lymph node involvement or in patients at high risk for pelvic involvement, simultaneous pelvic lymph node dissection (PLND) is performed.
ILND is associated with a high morbidity rate. Short-term surgical complications include wound infection, seroma formation, skin-flap problems, and wound breakdown. The reported incidence of early postoperative wound complications varies strongly in the current literature but can be as high as 77% [1], [2], [3], [4], [5], [6]. Over a longer period, lymphedema of the leg and/or the genital area may occur in varying degrees [2], [6], [7], [8], [9].
Previous studies in melanoma patients and vulvar cancer patients have tried to identify clinical risk factors for the occurrence of surgical complications after ILND [1], [4], [5], [7], [10]. To our knowledge, such attempts have not yet been made explicitly in patients with penile carcinoma, although complication rates have been compared for prophylactic dissection versus therapeutic and palliative dissection [11] and for radical ILND versus modified ILND [12].
Risk factors for any early surgical complication after ILND, as reported in the surgical literature, in patients with melanoma or vulvar cancer are age [1], [10], diabetes [10] and other comorbidity [1], body mass index (BMI) [1], [7], and drain production [10]. However, the presence of each risk factor is inconsistent and varies among studies [1], [7], [10].
Identification of risk factors for wound complications is clinically relevant. Therefore, we performed a historical cohort study, with two objectives: (1) to assess the frequency of early surgical wound complications after groin dissection for penile carcinoma and (2) to identify patient, tumour, and treatment characteristics as risk factors for the occurrence of early wound complications after ILND.
Section snippets
Data collection
We performed a chart review of all patients with penile cancer and ILND between 2003 and 2012 at the Netherlands Cancer Institute, a high-volume, specialised cancer hospital. Patients for whom the ILND was part of extensive resection that involved reconstructive surgery with myocutaneous flaps were excluded. We collected patient characteristics, tumour type and treatment characteristics, and data on early surgical wound complications, which were defined as complications occurring within 30 d
Complication rates
Between 2003 and 2012, 171 consecutively treated patients were identified who underwent an ILND. Eight patients were excluded due to additional reconstructive surgery. Another 73 patients had a bilateral dissection (45 of which were performed in a single procedure), and 1 patient had three procedures due to recurrence. The total number of ILNDs was 237 ILNDs in 163 patients. Table 1 summarises the patient characteristics.
One wound complication or more occurred in 58% of the procedures, with
Discussion
This study shows that even in a high-volume specialised centre, complication rates of ILND in penile carcinoma patients can be high. Our findings contrast with those of recently published studies in patients with penile cancer [2]. Complication rates in contemporary series (2002–2008) were between 49% and 57% when including lymphedema. Short-term morbidity in these studies was limited, with infection rates between 7.5% and 10% and wound-breakdown and necrosis rates between 2.5% and 11%. One
Conclusions
ILND is associated with a high wound-complication rate in patients with penile carcinoma, even in a high-volume, specialised cancer hospital. In this cohort, BMI, transposition of the sartorius muscle, and bilateral dissection were the factors most strongly associated with the occurrence of moderate to severe wound complications.
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