To Örebro University

Introduction: Curative penile cancer (PeCa) surgery was in 2015 centralized to two hospitals in Sweden. This study compares the use of lymph node surgery and complication rates before and after the centralization.

Method: All 1079 patients with invasive PeCa in the Swedish National Penile Cancer Register (NPECR) diagnosed between 2009 and 2020 were included, 458 before and 621 after centralization. Proportion of patients subjected to lymph node surgery 2009-2014 vs 2015-2020 was compared with Pearson’s Chi-squared test. Odds ratios (OR) for complications were calculated using a logistic regression model adjusting for age, nodal stage, and extent of penile surgery. Continuous variables were presented as medians with inter quartile ranges (IQR) and compared with Wilcoxon’s rank sum test.

Results: Before centralization 270/458 (59%) of patients were subjected to lymph node surgery compared to 474/621 (76%) after 2014. Overall complication rate for patients undergoing such surgery was similar (35%) before and after centralization. After Dynamic Sentinel Node Biopsy (DSNB) overall complications increased from 17% (22/126) to 32% (91/288) after centralization corresponding to an adjusted OR of 1.89 (95% confidence interval (CI) 1.09-3.27). For lymphocele, lymphedema or infection after modified or radical inguinal lymphadenectomy or pelvic lymphadenectomy, the adjusted OR was 0.47 (95% CI 0.29-0.75) after centralization. The register-based setting is a study limitation.

Conclusion: The proportion men receiving lymph node surgery increased and risk of lymphedema, lymphocele and infection after inguinal and pelvic lymph node surgery decreased after centralization of PeCa care.