Practice Patterns Among Penile Cancer Surgeons Performing Dynamic Sentinel Lymph Node Biopsy and Radical Inguinal Lymph Node Dissection in Men with Penile Cancer: A eUROGEN Survey

Christian D Fankhauser; Benjamin E Ayres; Allaudin Issa; Maarten Albersen; Nick Watkin; Asif Muneer; Vijay Sangar; Arie Parnham

doi:10.1016/j.euros.2020.12.009

Practice Patterns Among Penile Cancer Surgeons Performing Dynamic Sentinel Lymph Node Biopsy and Radical Inguinal Lymph Node Dissection in Men with Penile Cancer: A eUROGEN Survey

Eur Urol Open Sci. 2021 Jan 7:24:39-42. doi: 10.1016/j.euros.2020.12.009. eCollection 2021 Feb.

Authors

Christian D Fankhauser¹, Benjamin E Ayres², Allaudin Issa¹, Maarten Albersen³, Nick Watkin², Asif Muneer^{4

5

6}, Vijay Sangar¹, Arie Parnham¹

Affiliations

¹ Department of Urology, The Christie NHS Foundation Trusts, Manchester, UK.
² Department of Urology, St George's Hospital, London, UK.
³ Department of Urology, University Hospitals Leuven, Leuven, Belgium.
⁴ NIHR Biomedical Research Centre, University College London Hospital, London, UK.
⁵ Department of Urology, University College London Hospital, London, UK.
⁶ Division of Surgery and Interventional Science, University College London, London, UK.

Abstract

Dynamic sentinel lymph node biopsy (DSNB) and radical inguinal lymph node dissection (ILND) are important in the management of penile cancer patients, but high-level evidence for preoperative, perioperative, and postoperative management remains scarce. According to an online survey of 35 surgeons from ten European countries, 57% perform >10 ILND procedures per year and 86% offer DSNB. Furthermore, management differs substantially for dye injection site, use of lymphoscintigraphy, preferred incision sites, techniques for lymphatic control, duration of empiric antibiotic therapy, perioperative thromboprophylaxis, time points for drain removal, and definition of the ILND dissection floor. Consensus was observed for the use of perioperative antibiotics (although not duration and type) and the borders for ILND template definitions. We conclude that there is significant variation in patient management among eUROGEN penile cancer surgeons. This heterogeneity may confound multicentre studies; therefore, a consensus to standardise inguinal node management in penile cancer across European penile cancer centres is warranted.

Patient summary: Our survey reveals that preferences and surgical techniques for inguinal lymph node sampling and removal varies significantly between European penile cancer surgeons. Consensus is needed to standardise the management approach for penile cancer.

Keywords: Dynamic sentinel node biopsy; Inguinal lymph node dissection; Penile cancer.