The objective of this study is to compare the use of lymph node surgery and complication rates before and after centralization of penile cancer (PeCa) surgery in Sweden. In January 2015, curative surgical care for PeCa was centralized to the Skåne University Hospital in Malmö and the Örebro University Hospital in Örebro.
All 1079 patients with invasive PeCa in the Swedish National Penile Cancer Register (NPECR) diagnosed between 2009 and 2020 were included, 458 before and 621 after centralization. The proportion of patients subjected to lymph node surgery 2009-2014 versus 2015-2020 was compared using Pearson's Chi-squared test. Odds ratios (ORs) for complications were calculated using a logistic regression model adjusting for age, nodal stage and extent of penile surgery. Continuous variables were presented as medians and compared using Wilcoxon's rank sum test.
Before centralization, 270/458 (59%) of patients were subjected to lymph node surgery compared to 474/621 (76%) after 2014. Overall complication rate for patients undergoing such surgery was unaltered before and after centralization. The incidence of any complications increased after Dynamic Sentinel Lymph Node Biopsy from 18% (22/122) to 36% (91/256), corresponding to an adjusted OR of 1.89 (95% confidence interval [CI] 1.09-3.27). For lymphocele, lymphedema or infection after modified or radical inguinal or pelvic lymphadenectomy, the adjusted OR was 0.47 (95% CI 0.29-0.75) after centralization. The register-based setting is a study limitation.
The proportion of men undergoing lymph node surgery increased, and the risk of lymphocele, lymphedema and infection after inguinal and pelvic lymph node surgery decreased after centralization of PeCa care.
BJUI compass. 2026 Apr 30*** epublish ***
Åsa Warnolf, Gediminas Baseckas, Dominik Glombik, Oskar Hagberg, Peter Kirrander, Kimia Kohestani, Per Nordlund, Erik Persson, Fredrik Liedberg, Axel Gerdtsson
Department of Translational Medicine Lund University Malmö Sweden., Department of Urology Skåne University Hospital Malmö Sweden., Department of Urology, Faculty of Medicine and Health Örebro University Örebro Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden., Department of Urology Södersjukhuset Stockholm Sweden., Regional Cancer Center Uppsala Örebro Uppsala Sweden.