Mp11-11 validation and Implementation of a Mobile App Decision Support System for Quality Assurance of Multidisciplinary Tumor Boards (Mtd) to Optimize Management of Advanced Testicular Cancer

Abstract

patients, a complete inguinal lymph node dissection (ILND) might result in overtreatment and high morbidity rate. It is known that sentinel node (SN) biopsy is a valid alternative with fewer complications compared to ILND. This study evaluated the relationship between the number of lymph nodes (LNs) removed during SN biopsy in penile cancer patients and complications, using a standardized methodology to report complications.METHODS: 404 patients with !T1G2 penile squamous cell carcinoma with at least one cN0 groin were scheduled for SN biopsy and treatment of the primary tumour at a single centre. 90-day postoperative complications were collected according to the standardized methodology proposed by the European Association of Urology panel. Multivariable logistic regression analyses (MVA) were used to identify predictors of 90-day Clavien Dindo (CD)!IIIa and inguinal wound infection. Covariates consisted of age, cT (T1 vs. !T2) and cN status (cN0 vs. contralateral cN1), repeat SN biopsy and number of LNs removed. Lowess function graphically depicted the effect of the number of LNs removed on the probability to develop inguinal wound infection.RESULTS: Overall, the median number of LNs removed at SN biopsy was 4. Overall, 126 patients (31%) had postoperative complications. Of these, 67 (n[84) and 33% (n[42) were CD<IIIa and CD!IIIa, respectively. The most common complications were fever requiring antibiotics (n[90), inguinal wound infection (n[59), and lymphoceles (n[29). The readmission rate was 5% (n[20). cT2 or more (OR:2.6, p[0.01) and the number of LNs removed (OR:1.06, p[0.04) were the only independent predictors of 90-day CD!3 and inguinal wound infection, respectively. An increase in the probability of inguinal wound infection with the number of LNs removed was observed after accounting for all confounders (Fig. 1).CONCLUSIONS: SN biopsy is still associated with a substantial risk of wound infections. This risk increases with the increasing number of LNs removed. Therefore, techniques that further refine SN biopsy and enable the removal of less tissue/nodes are warranted, in order to further reduce morbidity compared to ILND.