Regional Recurrence

The regional recurrence rate is dependent on several factors: (1) development of a local recurrence with new lymphatic spread and concurrent regional recurrence, (2) initial nodal treatment (e.g., close surveillance, dynamic sentinel node biopsy, or elective lymphadenectomy), and (3) pathological nodal status. For example, patients who underwent penile-preserving surgery have a higher probability of local recurrence and are therefore at a higher risk for subsequent lymphatic spread.

Currently, the majority of patients are staged with minimally invasive staging techniques. Recurrence rates of patients with pathological node-negative (pN0) lymph nodes ranges from 0 to 3%, while recurrence rates of those with tumor-positive lymph nodes (pN+) are approximately 20%. Clinically node-negative patients who are managed with watchful waiting (pNX) generally have a 20% chance of regional recurrence. These rates depend on tumor stage,12,13 degree of differentiation,12-15 and the presence of lymphovascular invasion. i 3,16,17 Historical data indicate that the majority of inguinal recurrences in patients managed with surveillance typically develop within 2 years.18 Follow-up schedules regarding regional recurrences should therefore be strict during the initial 2 years of follow-up and becoming less frequent thereafter. Although the literature indicates that regional recurrence has a major impact on survival,1 successful salvage treatment is still possible. It is important to emphasize that data regarding recurrences are often variable depending on the treatment modalities that are employed for the patients e.g. close clinical surveillance, dynamic sentinel lymph node biopsy, or lymphadenectomy. Consequently, regional tumor recurrence in a patient may present a different management approach. For example, a patient managed with close clinical surveillance who subsequently develops a regional recurrence may be cured following an inguinal lymphadenec-tomy. On the other hand, a patient who develops an inguinal recurrence having already undergone an inguinal lymphadenectomy has a poor prognosis. Thus, the success of salvage treatment is clearly related to the initial treatment strategy.

Notwithstanding these differences, early detection (which may result in early salvage treatment) is oncologically sound. No data are available on the use of additional imaging techniques in facilitating the detection of recurrences. However, regular ultrasound investigation of the lymph nodes with fine-needle aspiration cytology (FNAC) of suspicious nodes may aid earlier detection of metastatic nodes that are not detected on physical examination.

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