Rodrigo Suarez-Ibarrola1, Friedemann Zengerling2, Marlene Haccius3, Steffen Lebentrau4, Hans-Peter Schmid5, Maximilian Bier6, Sebastian Lenart7, Florian A Distler8, Irene Resch9, Markus Oelschlager10, Matthias May3, Christian Bolenz2, Christian Gratzke11, Arkadiusz Miernik11, Gamal Anton Wakileh2. 1. Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany. Electronic address: rodrigo.suarez@uniklinik-freiburg.de. 2. Department of Urology, Ulm University Hospital, Ulm, Germany. 3. Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany. 4. Department of Urology, Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken, Neuruppin, Germany. 5. Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 6. Department of Urology, Bethel Evangelical Hospital, Bielefeld, Germany. 7. Department of Urology, Paracelsus Medical University, Salzburg, Austria; Department of Urology, St. John of God Hospital Vienna, Vienna, Austria. 8. Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany. 9. Department of Urology, Medical University of Vienna, Vienna, Austria. 10. Department of Urology and Pediatric Urology, Würzburg University Hospital, Würzburg, Germany. 11. Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany.
Abstract
BACKGROUND: Urologists' adherence to European Association of Urology and National Comprehensive Cancer Network guideline recommendations to perform inguinal (ILND) and pelvic (PLND) lymph node dissection in penile cancer (PC) patients is not known. OBJECTIVE: To assess a German-speaking European cohort of urologists based on their criteria to perform ILND and PLND in PC patients. DESIGN, SETTING, AND PARTICIPANTS: A 14-item survey addressing general issues of PC treatment was developed and sent to 45 clinical centers in Germany (n = 34), Austria (n = 8), Switzerland (n = 2), and Italy (n = 1). INTERVENTION: Two of the 14 questions assessed the criteria to perform ILND and ipsilateral PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Correct responses for ILND and PLND criteria were assessed. Based on a multivariate logistic-regression-model, criteria independently predicting guideline adherence were identified. RESULTS AND LIMITATIONS: In total, 557 urologists participated in the survey, of whom 43.5%, 19.3%, and 37.2% were residents in training, certified, and in leading positions, respectively. ILND and PLND criteria were correctly identified by 35.2% and 23.9%, respectively. Of the participants, 23.3% used external sources for survey completion. The use of auxiliary tools (odds ratio [OR] 1.57; p[bootstrapped] = 0.028) and participants outside of Germany (OR 0.56; p[bootstrapped] = 0.006) were predictors of ILND guideline adherence. The number of PC patients treated yearly (p = 0.012; OR 1.06) and the use of auxiliary tools (p < 0.001; OR 5.88) were predictors of PLND adherence. Department size, healthcare status, professional status, and responsibility for PC surgery did not predict endpoints. Limitations include sample size and results in comparison with retrospective studies. CONCLUSIONS: Our results demonstrate overall suboptimal knowledge of the correct indications to perform ILND and PLND in PC patients among the surveyed urologists. We propose that governments and healthcare providers should be encouraged to centralize PC management. PATIENT SUMMARY: The management of inguinal and pelvic lymph nodes is crucial for the survival of penile cancer patients. Disease rarity mandates referral to clinical practice guidelines for appropriate treatment selection.
BACKGROUND: Urologists' adherence to European Association of Urology and National Comprehensive Cancer Network guideline recommendations to perform inguinal (ILND) and pelvic (PLND) lymph node dissection in penile cancer (PC) patients is not known. OBJECTIVE: To assess a German-speaking European cohort of urologists based on their criteria to perform ILND and PLND in PC patients. DESIGN, SETTING, AND PARTICIPANTS: A 14-item survey addressing general issues of PC treatment was developed and sent to 45 clinical centers in Germany (n = 34), Austria (n = 8), Switzerland (n = 2), and Italy (n = 1). INTERVENTION: Two of the 14 questions assessed the criteria to perform ILND and ipsilateral PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Correct responses for ILND and PLND criteria were assessed. Based on a multivariate logistic-regression-model, criteria independently predicting guideline adherence were identified. RESULTS AND LIMITATIONS: In total, 557 urologists participated in the survey, of whom 43.5%, 19.3%, and 37.2% were residents in training, certified, and in leading positions, respectively. ILND and PLND criteria were correctly identified by 35.2% and 23.9%, respectively. Of the participants, 23.3% used external sources for survey completion. The use of auxiliary tools (odds ratio [OR] 1.57; p[bootstrapped] = 0.028) and participants outside of Germany (OR 0.56; p[bootstrapped] = 0.006) were predictors of ILND guideline adherence. The number of PC patients treated yearly (p = 0.012; OR 1.06) and the use of auxiliary tools (p < 0.001; OR 5.88) were predictors of PLND adherence. Department size, healthcare status, professional status, and responsibility for PC surgery did not predict endpoints. Limitations include sample size and results in comparison with retrospective studies. CONCLUSIONS: Our results demonstrate overall suboptimal knowledge of the correct indications to perform ILND and PLND in PC patients among the surveyed urologists. We propose that governments and healthcare providers should be encouraged to centralize PC management. PATIENT SUMMARY: The management of inguinal and pelvic lymph nodes is crucial for the survival of penile cancer patients. Disease rarity mandates referral to clinical practice guidelines for appropriate treatment selection.
Authors: Maximilian Pallauf; Marie C Hempel; Marie C Hupe; Matthias May; Marlene Haccius; Dorothea Weckermann; Steffen Lebentrau; Bernd Hoschke; Ulrike Necknig; Jesco Pfitzenmaier; Lukas Manka; Philipp Nuhn; Peter Törzsök; Lukas Lusuardi; Axel S Merseburger Journal: Adv Ther Date: 2020-10-10 Impact factor: 3.845
Authors: Steffen Lebentrau; Gamal Anton Wakileh; Martin Schostak; Hans-Peter Schmid; Rodrigo Suarez-Ibarrola; Axel S Merseburger; Georg C Hutterer; Ulrike H Necknig; Michael Rink; Martin Bögemann; Luis Alex Kluth; Armin Pycha; Maximilian Burger; Sabine D Brookman-May; Johannes Bründl; Matthias May Journal: Front Oncol Date: 2021-11-29 Impact factor: 6.244