Does the placement of a collagen-fibrin sealant reduce complications of radical inguinal lymph node dissection? - Comparative study in patients with penile cancer.

OBJECTIVE: Management of patients with penile cancer (PeC) with palpable inguinal lymph nodes (ILNs) relies on radical ILN dissection (RILND). Low burden of nodal metastatic disease may lead to long-lasting survival with surgical management. Nevertheless, RILND involves significant postoperative morbidity. We compared the complications of patients undergoing RILND with (RILND-T) and without (RILND-0T) placement of a collagen-fibrin sealant patch on the resection bed. MATERIALS AND METHODS: We conducted an observational retrospective study. Data from men submitted to RILND-T and RILND-0T from Jan/2001 to Feb/2022, in a tertiary care centre were compared. The primary endpoint was the overall incidence of complications until 1 month after the procedure and their respective severity in both cohorts (Clavien-Dindo classification system). Secondarily, length of hospital stay (LOHS) was analysed. The placement of a collagen-fibrin sealant patch was left at the surgeon's discretion. RESULTS: Seven patients underwent RILND-T and 20 underwent RILND-0T, respectively. There were no differences in pathologic TNM stage nor in the total number of ILNs removed (17 ± 4 vs. 20 ± 8, p = 0.37). Overall, 23 (85.2%) patients had complications. The complication rate was similar in both cohorts (85.7% vs 85%, p = 0.73). Surgical wound infection (3/7 vs. 11/20) and lymphocele (4/7 vs. 11/20) were the most reported complications. Patients undergoing RILND-T were discharged faster (mean length of hospital stay 9 ± 3 vs 19 ± 20 days, p = 0.22). CONCLUSIONS: The application of a collagen-fibrin sealant patch on the resection bed does not seem to reduce the postoperative complication rate in patients undergoing RILND. Nevertheless, a trend towards a shorter LOHS in patients with RILND-T cannot be excluded and should be validated by further studies with a higher number of patients.

Variant histologies of urothelial carcinoma: Does it change the survival outcomes in patients managed with radical cystectomy?

OBJECTIVE: To investigate the impact of variant histologies (VH) of urothelial carcinoma (UC) on survival outcomes after radical cystectomy (RC). MATERIALS AND METHODS: Data from 181 patients with UC treated with RC between January 2013 and December 2019 at a single tertiary care referral center were retrospectively accessed. All RC specimens were assigned by genitourinary dedicated pathologists. Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier methodology and the Cox proportional hazards regression. RESULTS: Of 181 patients, 43.1% (n = 78) had VH, with the most common being squamous differentiation (n = 29), followed by mixed variants (n = 18), micropapillary variant (n = 10) and other subtypes (n = 21). The median (range) follow-up was 35 (18-59) months. Kaplan-Meier survival analysis shows that median OS and DS were significantly worse for VH patients (78 vs 31 months, p = 0.038; not reached vs 42 months; p = 0.016). At 5 years, VH was associated with a 12% and 14% decrease in OS and DSS, respectively. No significant statistical difference between the two groups was reached regarding RFS. However, after adjusting for confounders, such as, demographics characteristics, comorbidities and pathological features, VH were not associated with any survival outcomes. CONCLUSIONS: Our study evidenced the high incidence of bladder cancers with VH. Although clearly associated with features of more aggressive behavior, VH had not any significant impact in survival expectancies when all confounders are adjusted in multivariate analyses.