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Title: Penile Cancer: Contemporary Lymph Node Management.
Austin Authors: O'Brien, Jonathan S;Perera, Marlon ;Manning, Todd G ;Bozin, Mike;Cabarkapa, Sonja;Chen, Emily;Lawrentschuk, Nathan
Affiliation: Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: Jun-2017
Date: 2017-01-20
Publication information: The Journal of urology 2017; 197(6): 1387-1395
Abstract: In penile cancer, the optimal diagnostics and management of metastatic lymph nodes are not clear. Advances in minimally invasive staging, including dynamic sentinel lymph node biopsy, have widened the diagnostic repertoire of the urologist. We aimed to provide an objective update of the recent trends in the management of penile squamous cell carcinoma, and inguinal and pelvic lymph node metastases. We systematically reviewed several medical databases, including the Web of Science® (with MEDLINE®), Embase® and Cochrane databases, according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) 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 reviewed, including original research, reviews and clinical guidelines published between 1980 and 2016. Accurate and minimally invasive lymph node staging is of the utmost importance in the surgical management of penile squamous cell carcinoma. In patients with clinically node negative disease, a growing body of evidence supports the use of sentinel lymph node biopsies. Dynamic sentinel lymph node biopsy exposes the patient to minimal risk, and results in superior sensitivity and specificity profiles compared to alternate nodal staging techniques. In the presence of locoregional disease, improvements in inguinal or pelvic lymphadenectomy have reduced morbidity and improved oncologic outcomes. A multimodal approach of chemotherapy and surgery has demonstrated a survival benefit for patients with advanced disease. Recent developments in lymph node management have occurred in penile cancer, such as minimally invasive lymph node diagnosis and intervention strategies. These advances have been met with a degree of controversy in the contemporary literature. Current data suggest that dynamic sentinel lymph node biopsy provides excellent sensitivity and specificity for detecting lymph node metastases. More robust long-term data on multicenter patient cohorts are required to determine the optimal management of lymph nodes in penile cancer.
DOI: 10.1016/j.juro.2017.01.059
ORCID: 0000-0002-1138-6389
Journal: The Journal of urology
PubMed URL: 28115191
Type: Journal Article
Subjects: amputation
neoplasm metastasis
sentinel lymph node biopsy
squamous cell
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