Linfadenectomía inguinal videoendoscópica modificada por abordaje suprafascial: descripción de la técnica y resultados quirúrgicos preliminares / Modified videoendoscopic inguinal lymphadenectomy through suprafascial approach: Technical description and preliminary surgical outcomes

Introducción: La disección de los ganglios linfáticos inguinales mediante abordaje videoendoscópico (LIVE) se ha planteado como una alternativa óptima para disminuir la morbilidad y mantener un control oncológico equivalente al del abordaje convencional. Uno de los pasos de mayor complejidad de la técnica es la elaboración de un plano de disección adecuado y entre sus ventajas está una exposición mejorada del campo quirúrgico. El objetivo de este estudio es determinar la viabilidad, en términos de seguridad y control oncológico, de una modificación de la técnica LIVE convencional, utilizando un plano de disección suprafascial, en una serie inicial de pacientes.Pacientes y métodos: Se llevó a cabo una revisión retrospectiva en un único centro de los pacientes tratados con LIVE mediante nuestra modificación de abordaje suprafascial. Se proporciona una descripción de la técnica quirúrgica paso a paso. Los datos recogidos incluyeron las características demográficas y de la enfermedad, las comorbilidades y los factores intra- y postoperatorios.Resultados: Se incluyó a un total de 7 pacientes (12 procedimientos). La edad media era de 64,42 años y el 71,42% de los pacientes eran hombres. El procedimiento se realizó de forma bilateral en el 71,4% de los casos. La mediana de pérdida de sangre estimada fue de 10mL (rango 10-25). El tiempo quirúrgico medio fue de 115 min (rango 120-170). La mediana del número de ganglios linfáticos obtenidos fue de 10,25 ganglios (rango 7-11). Solo un paciente (8,3%) experimentó una complicación de grado iiia de Clavien-Dindo, lo que requirió recambio del drenaje percutáneo. La mediana de tiempo hasta la retirada del drenaje fue de 13 días (rango 10-16). La mediana de duración de la estancia hospitalaria fue de 48 h, oscilando entre 24 y 96 h en toda la serie. (AU)

Introduction: The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients.Patients and methods: A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors.Results: A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10mL (range 10-25). Mean operative time was 115 minutes (range 120-170). Median number of nodes removed was 10.25 (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48hours but ranged from 24-96hours within the series.Conclusions: The modified Video Endoscopic Inguinal Lymphadenectomy (VEIL) technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy. (AU)

Modified videoendoscopic inguinal lymphadenectomy through suprafascial approach: Technical description and preliminary surgical outcomes.

INTRODUCTION: The videoendoscopic approach to inguinal lymph node dissection (VEIL) has been suggested as an excellent alternative carrying lower morbidity but equivalent oncological control. One of its most difficult steps is the development of an appropriate plane of dissection. A suprafascial approach would allow for better exposure. The objective of this study is to determine the feasibility, in terms of safety and oncological control, of a technical modification to the classical VEIL technique using a suprafascial plane of dissection in an initial series of patients. PATIENTS AND METHODS: A single institution retrospective review of patients undergoing VEIL technique using our modified suprafascial approach was conducted. A step-by-step surgical description is provided. Data collected included demographics; comorbid conditions; disease characteristics; intraoperative factors; and postoperative factors. RESULTS: A total of 7 patients (12 procedures) were included. Average age was 64.42 years old, and 71.42% of the patients were male. The procedure was performed bilaterally in 71.4% of the cases. Median estimated blood loss was 10 mL (range 10-25). Mean operative time was 185 min (range 120-170). Median number of nodes removed was 10.25 nodes (range 7-11). Only one of the patients (8.3%) experienced a Clavien-Dindo grade IIIa complication requiring delayed percutaneous drainage replacement. Median time until drainage removal was 13 days (range 10-16). Median length of stay was 48 hours but ranged from 24-96 hours within the series. CONCLUSIONS: The modified VEIL technique using a suprafascial plane of the dissection, allows a bilateral ILND in highly competitive operative times and with limited morbidity, without compromising its oncological efficacy.

Técnica PISA: nueva técnica mínimamente invasiva de acceso único para la linfadenectomía pélvica e inguinal en el cáncer de pene / Pelvic and inguinal single-site approach: PISA technique. New minimally invasive technique for lymph node dissection in penile cancer

Objetivos Describir nuestra experiencia inicial con un novedoso abordaje laparoscópico inguinal y pélvico de acceso único mínimamente invasivo para realizar la disección de los ganglios linfáticos (DGL) en el cáncer de pene: la técnica de acceso único pélvico e inguinal (PISA, por las siglas en inglés de Pelvic and Inguinal Single Access).Material y métodos 10 pacientes en diversos estadios de carcinoma de células escamosas de pene (cN0 y ≥ pT1G3 o cN1/cN2) fueron operados mediante la técnica PISA entre 2015-2018. Se realizaron secciones congeladas intraoperatorias de forma rutinaria y se llevó a cabo secuencialmente la DGL pélvica ipsilateral como procedimiento en un solo acto y utilizando las mismas incisiones quirúrgicas ante la detección de ≥ 2 ganglios inguinales(pN2) o extensión ganglionar extracapsular (pN3). Variables: complicaciones posquirúrgicas a 30 días, pérdida de sangre estimada (PSE), tasa de transfusión, tiempo quirúrgico, tiempo hasta la retirada del drenaje y duración de la estancia hospitalaria (DEH). Las medianas y los rangos de los valores de las variables seleccionadas se presentaron como estadísticas descriptivas.Resultados La DGL inguinal fue bilateral en todos los casos y la DGL pélvica fue necesaria en el 40%. El tiempo quirúrgico total fue de 120-170 minutos y la mediana de PSE fue de 66 (30-100) cc. En ningún caso se requirió transfusión sanguínea. No se observaron complicaciones intraoperatorias y la tasa de complicaciones postoperatorias fue del 40% (10% de complicaciones mayores: linfocele inguinal sintomático). La mediana de la estancia hospitalaria fue de 5,8 (3-10) días. La mediana de tiempo hasta la retirada del drenaje inguinal fue de 4,7 días. Número medio de ganglios linfáticos extirpados mediante DGL inguinal: 10,25(8-14). Experiencia retrospectiva de volumen limitado de un centro de referencia con un seguimiento corto.

Objectives To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique.Material and Methods 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. Variables: 30-day postoperative complicactions, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics.ResultsInguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170minutes and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications- symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25(8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills.Conclusions PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications

Pelvic and inguinal single-site approach: PISA technique. New minimally invasive technique for lymph node dissection in penile cancer.

OBJECTIVES: To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique. MATERIAL AND METHODS: 10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. VARIABLES: 30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics. RESULTS: Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills. CONCLUSIONS: PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications.

Carcinoma uretral primario: resultados de la experiencia de un único centro / Primary urethral carcinoma: Results from a single center experience

Introducción y objetivo El carcinoma primario de uretra (CPU) es una enfermedad neoplásica poco frecuente que surge en la uretra, sin evidencia de carcinoma previo o sincrónico en todo el tracto urinario. Dado que las enfermedades raras suelen diagnosticarse y tratarse de forma incorrecta, el objetivo de este estudio fue analizar la experiencia de un único centro urológico en el tratamiento del CPU, centrándose en las neoplasias que surgen de la uretra anterior masculina.Materiales y métodos Se revisaron retrospectivamente las historias clínicas de los pacientes con neoplasias a nivel de la uretra peneana y bulbar que se presentaron en nuestro centro terciario de referencia entre enero de 1988 y diciembre de 2018. Se excluyeron los pacientes con carcinoma de la uretra prostática. El diagnóstico se obtuvo con la ayuda de una uretroscopia y biopsia de la lesión. El estadio patológico local se evaluó mediante resonancia magnética nuclear (RMN) con contraste en pacientes seleccionados. El estadiaje se evaluó mediante examen clínico, ecografía y tomografía computarizada (TC). La cirugía radical (cistectomía radical + penectomía total + linfadenectomía inguinal bilateral) se propuso a los pacientes con tumores ≥ T2 o cN + con un buen estado funcional, tumor proximal y sin comorbilidades graves. En caso de afectación ganglionar, se ofreció adicionalmente quimioterapia neoadyuvante. Los pacientes con enfermedad localizada (< T2) y/o tumor más distal fueron sometidos a uretrectomía o penectomía parcial. Se evaluaron las curvas de Kaplan-Meier para el análisis de la supervivencia global (SG), la supervivencia cáncer específica (SCE) y la supervivencia libre de recidiva (SLR).Resultados Se estudiaron retrospectivamente un total de 13 pacientes varones con CPU anterior. Se realizó penectomía total en siete casos, mientras que cinco casos recibieron uretrectomía parcial y un caso, penectomía parcial. De los siete pacientes que se sometieron a una

Introduction and aim of the study Primary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra.Materials and methods Medical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN + with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease (ResultsA total of 13 male patients with anterior PUC were studied retrospectively. Total penectomy was performed in 7 cases, while partial urethrectomy was performed in 5 cases, and partial penectomy in 1 case. Of the 7 patients who underwent total penectomy, 5 underwent radical cystectomy with bilateral inguinal lymphadenectomy. Three patients were treated with neoadjuvant systemic chemotherapy, of which 2 were cT3N + and

Primary urethral carcinoma: Results from a single center experience.

INTRODUCTION AND AIM OF THE STUDY: Primary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra. MATERIALS AND METHODS: Medical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN+ with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease (

Primary urethral carcinoma: Results from a single center experience. / Carcinoma uretral primario: resultados de la experiencia de un único centro.

INTRODUCTION AND AIM OF THE STUDY: Primary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra. MATERIALS AND METHODS: Medical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN + with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease (

[Penile cancer in Mexico: Twenty years experience at a tertiary academic hospital.] / Cáncer de pene en México: 20 años de experiencia en un hospital académico de tercer nivel.

OBJECTIVE: The aim of this study was to report clinical features and management of penile cancer (CP) at the National Cancer Institute (INCan) of Mexico City over 20 years. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 405 cases of primary penile cancer (PC) treated at our institution between 1989 until 2015. Diagnosis, treatment and oncological outcomes are reported. RESULTS: Clinicopathologic and demographic information was available for 375 patients (mean age, 56 ys). At diagnosis, 140 (37.3 %) patients were cN0, 71(18.9%) cN1, 164 (43.37%) cN2 and 33 (8%) cN3. 14% had metastatic disease (lung and bone). Initial treatment included partial penectomy (n=123; 33.6%), and total penectomy (n=126;33.6%). 138 (36.2%) patients with high risk disease underwent bilateral inguinal lymph node dissection. 8% (56) had positive lymph nodes. Kaplan-Meier survival analysis showed a 10-year CSS (cancer specific survival) rate of 70%. There was no significant difference in CSS when stratifying per age. Five-year CSS for pT1, pT2, pT3 and T4 was 96%, 88%, 58% y T4 0%, respectively. A difference in CSS was found between pT2 and pT3 (p=0.047). CONCLUSION: The findings of our descriptive analysis provide information on natural history of penile cancer in Mexico. The surgical penile removal of the primary tumour remains standard of care. There was no difference in survival for age group.

OBJETIVO: Revisar las características clínicas y el manejo del cáncer de pene (CP) en el Instituto Nacional de Cancerología (INCan) de la Ciudad de México en 20 años de experiencia.MATERIAL Y MÉTODOS: Revisamos de forma retrospectiva a 405 pacientes con diagnóstico de CP tratados en INCan entre enero de 1989 hasta diciembre de 2015. Se describieron la modalidad de presentación de los casos, los resultados de patología, tratamiento y la sobrevida. RESULTADOS: Las informaciones clínico-patológicas y los resultados oncológicos fueron completas en 375 pacientes (edad media 56,82). Al diagnóstico 140 casos (n.37,3%) fueron cN0, 71 casos (18,9%) cN1, 164 casos (43,37%) cN2, 33 casos (8%) cN3. El 14% tuvieron metástasis a distancia (pulmón, huesos). El tratamiento inicial incluyó falectomía parcial (n=123; 33,6% y falectomía total (n=126; 33,6%). De 138 (36,2%) pacientes de alto riesgo sometidos a disección de ganglios linfáticos inguinales bilaterales, solo el 8% (n.56) tenían ganglios linfáticos positivos. El análisis de supervivencia de Kaplan-Meier mostró una tasa de SCE (sobrevida cáncer específica) a 10 años del 70%. No hubo diferencias significativas en la supervivencia para el grupo de edad. La CSS a 5 años para pT1, pT2, pT3 y T4 fue del 96%, 88%, 58% y 0%, respectivamente. Se encontró diferencia en la supervivencia entre pT2 y pT3 (p 0,047).CONCLUSIÓN: Los hallazgos de nuestra casuística proporcionan información sobre la historia natural del cáncer de pene en México. La amputación quirúrgica del tumor primario sigue siendo el patrón uro-oncológico para el tratamiento definitivo del CP. No hubo diferencias en la supervivencia para el grupo de edad.

[Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review.] / Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática.

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes in video-endoscopic inguinal lymphadenectomy (VEIL). METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower- rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results.

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL).MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CCONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo.

Modified endoscopic left inguinal lymphadenectomy.

INTRODUCTION: Endoscopic Inguinal Lymphadenectomy is an evolution of laparoscopic surgery thanks to background in these techniques. This is a new technique and the indications in the field of penile tumors today are expanding. The technique aims at reducing the morbidity of the procedure without compromising the cancer control or reducing the template of the dissection. MATERIAL AND METHODS: We present the modified endoscopic inguinal lymphadenectomy in a 70 years-old male patient with penile melanoma and positive sentinel lymph node in left inguinal limb. Intraoperative data, pathology, post operatory evolution and oncological follow-up is described RESULTS: Operative time was 120 min. Nine lymph nodes were retrieved and none of then showed positivity at pathology. There were no complications. The drain was kept for five days. After 12 months of follow up, no signs of disease progression were noted. CONCLUSION: The endoscopic inguinal lymphadenectomy is feasible in clinical practice. New studies with a greater number of patients and long-term follow-up may confirm the oncological efficacy and possible lower morbidity of these new approach.

Avaliação dos gânglios regionais no carcinoma epidermóide do pênis (cep) através de um índice de risco

The aim of this study was to investigate the predictive value of a risk index (RI) based on tumor pT stage and grade on the prognosis for inguinal lymphactic metastasis. We included 53 patients bearing schamous cell carcinoma of the penis (SCCP) treated by penectomy at the Hospital das Clínicas da FMRP-USP from 1978 to 1995. Age range varied from 32 to 97 years. Tumor grading was determined according to Broders method and staging by 1999 TNM system. RI was calculated by the sum of pT stage and grade (RI = pT+G). Bilateral inguinal lymphdenectomy was carried out within 6 weeks the penectomy in 14 patients cN+ at the presentation. The remaining 36 cases were kept under surveillance. In 9 of these patients required a delayed regional lymphadenectomy due to nodal relapse (median follow-up: 9 months). Proportions of pN0 patients according to RI were: 92% - 2, 80% - 3 and 0% - 6. The proportion of pN+ patients with a pooled RI of 4, 5 and 6 was significantly higher than that seen in pooled cases with lower RI (p = 0,004). From 36 patients initially cN0, 27 were RI 2 or 3 ( 5 of them progressed later on to pN+ , 19%) and 9 were RI ³ 4 (3 of them had progression to lymphatic spread, 33%). But, the difference observed in cN0 patients was not significant (p = 0,3). In conclusion, patients with RI ³ 4 were at higher risk of nodal spread when the overall sample was at stake, but this cutoff level for RI had no predictive value for the patients that were initially cN0.

O objetivo desse estudo foi investigar a validade de um índice de risco (IR) no prognóstico de metástases ganglionares no carcinoma epidermóide do pênis (CEP). Foram analisados 53 pacientes com CEP atendidos no Hospital das Clínicas da FMRP-USP, de janeiro de 1978 a dezembro de 1995. A idade variou de 32 a 97 anos. Os tumores foram graduados de acordo com a classificação de Broders e estadiados retrospectivamente (TNM 1999). O IR foi determinado pela soma de TeG (IR = T+G). A linfadenectomia inguinal bilateral (LD) foi indicada naqueles que apresentaram gânglios suspeitos após a antibioticoterapia ou que vieram apresentar alterações durante o período de observação. Faleceram 17 pacientes; A LD foi realizada em 14 pacientes e os 39 restantes permaneceram em observação clínica, sendo que em 8 deles foi feito LD após tempo mediano de 9 meses. Dos pacientes com índice de risco 2 e 3 92% e 80% respectivamente não apresentavam metastase ganglionar, ao passo que a totalidade daqueles com IR=6 tinha gânglios comprometidos. A associação dos grupos 2 e 3, comparada ao conjunto 4, 5 e 6, mostrou percentual maior de comprometimento nestes últimos (p = 0,0046). Dos 36 pacientes inicialmente No, 27 apresentavam IR 2 ou 3, dos quais 5 evoluíram para N+ (19%); os 9 restantes eram IR > 4 e 3 também evoluíram para N+ (33%). Apesar da diferença, não houve significância estatística entre eles (p = 0,3837). Embora tenha ocorrido maior comprometimento naqueles com IR > 4, o índice de risco não foi capaz de identificar previamente pacientes que evoluíram para N+.