Penile/Urethral Ca: Robotic inguinal lymph node dissection feasible

Other penile/urethral cancer highlights from AUA 2018 included analyses of fludeoxyglucose positron emission tomography-computed tomography and the Pl3K-AKT-mTOR pathway. The take-home messages were presented by Christopher Warlick, MD, PhD, of the University of Minnesota, Minneapolis.

• Robotic inguinal lymph node dissection is feasible, with similar overall rates of complications as open lymph node dissection. But the grade of complication may be higher. Out of 17 patients who underwent salvage surgery for radiation failure in penile cancer from 1976 to 2013, 68.8% survived a year, 35.7% survived 3 years, and 10.7% survived 10 years. A review of the cases suggested surgeons should use organ-sparing approaches when possible, wide local excision for bulky tumors, and forethought during resection to maintain reconstructive options. Complex reconstructive cases may require multidisciplinary input and benefit from centralization at centers of excellence.
• Lymph node dissection is important for clinical stage N1-N2 urethral cancer. The value of lymph node dissection for clinical N0 disease is less clear, but may depend on the patient population and type of dissection performed.
• A retrospective analysis of patients undergoing fludeoxyglucose (FDG) positron emission tomography-computed tomography for staging of pelvic lymph nodes in patients with known inguinal metastases of penile cancer showed a sensitivity of 77% and a specificity of 88%.
• In a study of men with squamous cell carcinoma of the penis, there was no difference in 3-year overall survival between negative and positive node dissection patients with micro-metastatic pelvic lymph node involvement.
• In another study of squamous cell carcinoma of the penis, FDG-PET/CT appeared helpful in identifying men with positive pelvic lymph nodes. Men with high-risk inguinal nodal features had a high rate of pelvic micrometastatic disease, but lymph node dissection did not affect overall survival. And men with positive inguinal nodes had a significant rate of contralateral nodal disease identified by sentinel lymph node dissection.
• The Pl3K-AKT-mTOR pathway has prognostic significance, and checkpoint inhibitor pathways may be suitable therapeutic targets in penile cancer.