Long-term outcomes of dynamic sentinel lymph node biopsy in clinically node-negative penile cancer.

Abstract

5039 Background: Dynamic sentinel lymph node biopsy (DSLNB) has emerged as a viable alternative in management of clinically node-negative (cN0) penile cancers owing to the high morbidity associated with radical inguinal lymphadenectomy. However, data on efficacy of DSLNB in penile cancer is limited. This study analyses the long-term outcomes of DSLNB in patients with cN0 penile cancer. Methods: A retrospective analysis of patients who underwent DSLNB with dual technique (blue dye + radiocolloid) for cN0 penile cancer was done. Data was collected between 2010 to 2018 from a prospectively maintained database with a median follow up of 70.36 months (range - 4 to 150 months). Patients under all risk groups of the European Association of Urology (EAU) Risk Stratification were included. Results: The study included 168 consecutive patients who underwent DSLNB (307 groins). Glans penis was the commonest site of disease (92.9%). Partial penectomy was the most common type of surgery for the primary (72.1%). Median number of sentinel nodes identified was three. Based on the EUA risk stratification, 57.2% of the cases were in the high-risk group. Identification rate with dual technique DSLNB in our study was 98.5%. Clavien-Dindo score of 2 or more was seen in 3.57% of patients. A nodal recurrence was seen in 8 groins (8 patients) with a mean time to recurrence of 430 days (69 to 1355 days). This corresponds to a DSLNB false negative rate of 2.6% with median inguinal node recurrence-free survival of 74.4 months. Conclusions: In our institution, DSLNB was done with a false negative rate of 2.6% and an acceptable morbidity. The low rate of inguinal nodal recurrence shows the utility of SLNB in staging cN0 groins. By using DSLNB we have avoiding a potentially morbid inguinal dissection in 81.4% of patients with clinically node negative disease.