To Örebro University

Introduction & Objectives: To assess the rate of postoperative infectious and thromboembolic complications associated with inguinal (ILND) and pelvic (PLND) lymph node dissection in penile cancer and identify clinical and pathological predictors for the development of these complications.

Materials & Methods: A total of 364 men subjected to ILND with or without PLND for squamous cell carcinoma of the penis between 2000 and 2012 were identified through the Swedish National Penile Cancer Register. Each patient was matched based on age and county of residence with 6 penile cancer-free men. The Swedish cancer and population registers were used to retrieve information about treatment and hospitalization for infections of the lower limbs, groins, genitalia, trunk and various septic conditions as well as thromboembolic events based on ICD-10 codes for each event. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazard models with multiple imputation to assess the effects of different variables. The net hazard rates of outcomes were estimated using a flexible parametric model.

Results: The risk to suffer from infectious events remained increased up to 6 years postoperatively in penile cancer patients who underwent ILND in comparison to the matched controls. Palpable nodal disease was the only predictor of increased risk of infectious complications. The risk tends to increase with the cN stage, with a HR of 1.65 (95% CI 0.98-2.77) for cN1, 1.93 (95% CI 1.14-3.29) for cN2 and 2.62 (95% CI 1.41-4.88) for cN3 disease. Risks for the first, third and sixth postoperative year were assessed with HRs of 8.87 (95% CI 5.36-14.66), 4.20 (95% CI 2.77-6.35) and 1.83 (95% CI 0.96-3.46) respectively. The increased risk of thromboembolic events persisted up to 3 years postoperatively, HRs for the first and third postoperative year were 13.51 (95% CI 6.53-27.93) respectively 2.12 (95% CI 1.07-4.20). The results correspond well with the over-prescription of anticoagulants observed during this period. An association with bulky disease was observed, with a HR of 3.81 (95% CI 1.10-13.17) for cN3 stage. PLND did not add any excessive risks for either infectious or thromboembolic events.

Conclusions: Based on data from nationwide registers of high quality and completeness, we could assess postoperative morbidity after lymphadenectomy for penile cancer with follow-up length ranging up to 12 years. Patients with palpable nodal disease are at increased risk of infectious complications up to 6 years postoperatively. The risk of thromboembolic complications was increased during first 3 postoperative years. Patients and care givers need to be aware of the increased risk of these complications and preventive measures should be considere