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|Title:||Penile cancer: contemporary lymph node management|
|Authors:||O'Brien, Jonathan S;Perera, Marlon;Manning, Todd G;Bozin, Mike;Cabarkapa, Sonja;Chen, Emily C;Lawrentschuk, Nathan L|
|Citation:||Journal of Urology 2017; online first: 20 January|
|Abstract:||In penile cancer, optimal diagnostics and management of metastatic lymph nodes is not clear. Advances in minimally invasive staging, including dynamic sentinel lymph node biopsy (DSLNB) have widened the diagnostic repertoire of the urologist. We aimed to provide an objective update in the recent trends in the management of penile SCC and inguinal and pelvic lymph node metastases. METHODS: We systematically reviewed several medical databases including: Web of Science (including MEDLINE), EMBASE and Cochrane databases according to PRISMA guidelines. The search terms used were "penile cancer", "lymph node", "sentinel node", "minimally invasive", "surgery" and "outcomes", alone and in combination. Articles pertaining to the management of lymph nodes in penile cancer were review, including: original research, reviews and clinical guidelines published between 1980 and 2016. RESULTS: Accurate and minimally invasive lymph-node staging is of utmost importance in the surgical management of penile SCC. In clinically node negative patients, a growing body of evidence supports in the use of sentinel lymph node biopsies. DSLNB exposes the patient to minimal risk and results in superior sensitivity and specificity profiles when compared to alternate nodal staging techniques. In the presence of locoregional disease, improvements in inguinal or pelvic lymphadenectomy have reduced morbidity and improved oncological outcomes. A multimodal approach of chemotherapy and surgery has demonstrated a survival benefit for patients with advanced disease. CONCLUSIONS: Recent developments in lymph node management have occurred in penile cancer, such as minimally invasive LN diagnosis and intervention strategies. These advances have been met with a degree of controversy in contemporary literature. Current data suggests that DSLNB provides excellent sensitivity and specificity in detecting lymph node metastases. More robust long-term data from multicenter patient cohorts is required to determine the optimal management of lymph nodes in penile cancer.|
|Appears in Collections:||Journal articles|
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