Skip to main content

Advertisement

SpringerLink
Log in

Sarcopenia as a predictor of complications in penile cancer patients undergoing inguinal lymph node dissection

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Lymphadenectomy (LND) is part of the surgical management of penile cancer but causes significant perioperative morbidity. We determined whether sarcopenia, a novel marker of nutritional status, is a predictor of postoperative complications after LND.

Materials and methods

Seventy-nine patients underwent LND for penile cancer from 1999 to 2014, and 43 had available preoperative abdominal imaging. Skeletal muscle index (SMI) was calculated on axial computed tomography images at the third lumbar vertebrae, and an SMI of 55 cm2/m2 was used to classify patients as sarcopenic versus not. This classification was then correlated with postoperative complications and survival.

Results

Median lumbar SMI was 54.7 cm2/m2 with 22 (51.2 %) patients categorized as sarcopenic versus 21 (48.8 %) who were not. Twenty-seven postoperative complications occurred in 20 patients within 30 days, of which 11 (40.7 %) were major (Clavien score ≥IIIa) and 16 (59.3 %) were minor. The most common complications were wound dehiscence (25.9 %), wound infection (18.5 %), lymphocele (18.5 %), and flap necrosis (14.8 %). On univariate analysis, the presence of sarcopenia, nodal disease, and lymphovascular invasion were predictors of postoperative complications. On multivariate analysis, only sarcopenia was an independent predictor of 30-day complications [p = 0.038; 95 % confidence interval (CI) 1.1–21.1]. Although sarcopenia was not statistically associated with worse overall survival (OS), there was a trend toward poorer outcomes in these patients.

Conclusions

Sarcopenia can be a useful prognostic tool to predict the likelihood of postoperative complications after LND for penile cancer. Preoperative nutritional supplementation may help reduce complication rates in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64:9–29

    Article  PubMed  Google Scholar 

  2. Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (2009) Penile cancer: epidemiology, pathogenesis and prevention. World J Urol 27:141–150

    Article  CAS  PubMed  Google Scholar 

  3. Stern RS, Bagheri S, Nichols K, Study PFU (2002) The persistent risk of genital tumors among men treated with psoralen plus ultraviolet A (PUVA) for psoriasis. J Am Acad Dermatol 47:33–39

    Article  Google Scholar 

  4. Pizzocaro G, Algaba F, Horenblas S, Solsona E, Tana S, Van Der Poel H, Watkin NA (2010) European association of urology guidelines group on penile C: EAU penile cancer guidelines 2009. Eur Urol 57:1002–1012

    Article  PubMed  Google Scholar 

  5. Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173:816–819

    Article  CAS  PubMed  Google Scholar 

  6. Catalona WJ (1988) Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 140:306–310

    CAS  PubMed  Google Scholar 

  7. Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA (2013) Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes. J Urol 190:2086–2092

    Article  PubMed  Google Scholar 

  8. Ramos Chaves M, Boleo-Tome C, Monteiro-Grillo I, Camilo M, Ravasco P (2010) The diversity of nutritional status in cancer: new insights. Oncologist 15:523–530

    Article  PubMed Central  PubMed  Google Scholar 

  9. Psutka SP, Carrasco A, Schmit GD, Moynagh MR, Boorjian SA, Frank I, Stewart SB, Thapa P, Tarrell RF, Cheville JC, Tollefson MK (2014) Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer-specific and all-cause mortality. Cancer 120:2910–2918

    Article  PubMed  Google Scholar 

  10. Smith AB, Deal AM, Yu H, Boyd B, Matthews J, Wallen EM, Pruthi RS, Woods ME, Muss H, Nielsen ME (2014) Sarcopenia as a predictor of complications and survival following radical cystectomy. J Urol 191:1714–1720

    Article  PubMed  Google Scholar 

  11. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107:931–936

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006

    Article  PubMed  Google Scholar 

  13. Chen Y, Liu BL, Shang B, Chen AS, Liu SQ, Sun W, Yin HZ, Yin JQ, Su Q (2011) Nutrition support in surgical patients with colorectal cancer. World J Gastroenterol 17:1779–1786

    Article  PubMed Central  PubMed  Google Scholar 

  14. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495

    Article  PubMed  Google Scholar 

  15. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM et al (2010) Sarcopenia: european consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39:412–423

    Article  PubMed Central  PubMed  Google Scholar 

  16. Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547

    Article  PubMed  Google Scholar 

  17. Reisinger KW, van Vugt JL, Tegels JJ, Snijders C, Hulsewe KW, Hoofwijk AG, Stoot JH, Von Meyenfeldt MF, Beets GL, Derikx JP, Poeze M (2014) Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg [Epub ahead of print]

  18. Peng PD, van Vledder MG, Tsai S, de Jong MC, Makary M, Ng J, Edil BH, Wolfgang CL, Schulick RD, Choti MA et al (2011) Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB 13:439–446

    Article  PubMed Central  PubMed  Google Scholar 

  19. Tan BH, Birdsell LA, Martin L, Baracos VE, Fearon KC (2009) Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res 15:6973–6979

    Article  CAS  PubMed  Google Scholar 

  20. Robinson S, Cooper C, Aihie Sayer A (2012) Nutrition and sarcopenia: a review of the evidence and implications for preventive strategies. J Aging Res 2012:510801

    Article  PubMed Central  PubMed  Google Scholar 

  21. Waters DL, Baumgartner RN, Garry PJ, Vellas B (2010) Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv Aging 5:259–270

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S (2013) Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis. Eur Urol 64:486–492

    Article  PubMed  Google Scholar 

  23. Bevan-Thomas R, Slaton JW, Pettaway CA (2002) Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson Cancer Center Experience. J Urol 167:1638–1642

    Article  PubMed  Google Scholar 

  24. Baumgarten AS, Alhammali E, Hakky TS, Espiritu PN, Pow-Sang JM, Sexton WJ, Lockhart JL, Protzel C, Hakenberg O, Muneer A, Spiess PE (2014) Salvage surgical resection for isolated locally recurrent inguinal lymph node metastasis of penile cancer: international study collaboration. J Urol 192:760–764

    Article  PubMed  Google Scholar 

  25. Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G (2004) Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol 45:761–765; discussion 765–766

    Article  PubMed  Google Scholar 

  26. Yao K, Zou ZJ, Li ZS, Zhou FJ, Qin ZK, Liu ZW, Li YH, Han H (2013) Fascia lata preservation during inguinal lymphadenectomy for penile cancer: rationale and outcome. Urology 82:642–647

    Article  PubMed  Google Scholar 

  27. Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER (2007) Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 177:953–957; discussion 958

    Article  PubMed  Google Scholar 

  28. Tobias-Machado M, Tavares A, Silva MN, Molina WR Jr, Forseto PH, Juliano RV, Wroclawski ER (2008) Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol 22:1687–1691

    Article  PubMed  Google Scholar 

  29. Romanelli P, Nishimoto R, Suarez R, Decia R, Abreu D, Machado M, Arroyo C, Campolo H, Campos E, Carlos AS, Tobias-Machado M (2013) Video endoscopic inguinal lymphadenectomy: surgical and oncological results. Actas Urol Esp 37:305–310

    Article  CAS  PubMed  Google Scholar 

  30. Doumas BT, Peters T Jr (1997) Serum and urine albumin: a progress report on their measurement and clinical significance. Clin Chim Acta 258:3–20

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Ethical standard

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

  1. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Pranav Sharma, Kamran Zargar-Shoshtari, George J. Richard, Michael A. Poch, Julio Pow-Sang, Wade J. Sexton & Philippe E. Spiess

  2. Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, FL, USA

    Jamie T. Caracciolo

Authors
  1. Pranav Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamran Zargar-Shoshtari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jamie T. Caracciolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George J. Richard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael A. Poch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julio Pow-Sang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wade J. Sexton
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philippe E. Spiess
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe E. Spiess.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, P., Zargar-Shoshtari, K., Caracciolo, J.T. et al. Sarcopenia as a predictor of complications in penile cancer patients undergoing inguinal lymph node dissection. World J Urol 33, 1585–1592 (2015). https://doi.org/10.1007/s00345-014-1471-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1471-6

Keywords

Search

Navigation