Risk factors of complications after inguinal lymph node dissection in patients with penile cancer.

Abstract

6 Background: Inguinal lymph node dissection (ILND) is a crucial step in the management of patients with penile cancer, particularly for those with lymph node involvement. However, ILND is associated with a significant risk of postoperative complications, which can impact recovery and long-term outcomes. Identifying the risk factors that contribute to these complications may help in improving patients’ quality of life after ILND and perioperative management. Methods: We conducted a retrospective analysis of 192 penile cancer patients who underwent ILND between October 2008 and October 2023 at West China Hospital. 370 surgeries were conducted. Data on patient demographics, tumor characteristics, comorbidities, surgical details, and postoperative outcomes were collected. Complications were classified as minor or major based on the Clavien-Dindo classification. Multivariate logistic regression was performed to identify independent risk factors for each complications. Receiver operating characteristic (ROC) curves were used to analyze the relationship between certain risk factors and postoperative complications and find cut-off points for certain risk factors. Results: The overall complication rate was 87.5%, with most patients experiencing minor complications. Common complications included wound infections (35.4%), lymphatic fistula (50%), lymphocele (42.2%) and lower limb edema (28.6%). Except for the common risk factors, such as surgery type (conventional or minimally invasive, Odds Ratio (OR): 0.157, 95% Confidence Interval (CI): [0.036, 0.692], p =0.014) for wound infection, we additionally found that the shorter retention time of drainage tube (OR: 0.784, 95% CI: [0.724, 0.850], p <0.001) is strongly correlated with subsequent lymphocele, with cut-off points of 6.5 days. And longer retention time of drainage tube (OR: 1.065, 95% CI: [1.031, 1.100], p <0.001) is correlated with wound infection, with cut-off points of 10.5 days. Conclusions: Our study highlights several modifiable and non-modifiable risk factors associated with each complications following ILND in penile cancer patients. Optimizing perioperative care and conducting minimally invasive surgery when possible may reduce postoperative complication rate. And the duration of drainage tube retention is associated with both lymphocele and wound infection. Further prospective studies are warranted to validate these findings.