Trial of ligation versus coagulation of lymphatics in dynamic inguinal sentinel lymph node biopsy for staging of squamous cell carcinoma of the penis.

INTRODUCTION: The principal advantage of dynamic sentinel lymph node biopsy (DSNB) over modified inguinal node dissection is the lower complication rate. The aim of this study was to identify factors associated with short-term complications of DSNB in order to lower morbidity of the procedure. METHODS: Retrospective and prospective cohort studies were performed on patients undergoing DSNB between April 2005 and March 2010. Patients were categorised into three groups of 50 (from a total of 250 patients on the database). The patients of Group A, on whom ligaclips were the lymphovascular control technique, were compared with those of Group B, in whom diathermy was used. Incision length, operative time, number of nodes removed, antibiotics and co-morbidities were recorded. A prospective study on Group C, using ligaclips, was also performed. RESULTS: Groups A (88 groins), B (75 groins) and C (68 groins) were explored with complication rates of 5.7%, 24.0% (p =0.0018) and 8.8% (p =0.0277). Co-morbidities, antibiotics (co-amoxiclav 1.2g intravenous as per protocol) and the mean number of nodes removed were similar in all groups. The mean incision length was 4.1cm (standard deviation [SD]: 1.0 cm) for Group A, 5.6 cm (SD: 1.0 cm) for Group B (p =0.0001) and 5.6 cm (SD: 0.8 cm) for Group C (p =0.979). The mean operative times for Groups A, B and C were 15.8 (SD: 8.1), 19.3 (SD: 7.4) (p =0.0043) and 22.1 (SD: 7.7) (p =0.0301) minutes respectively. CONCLUSIONS: Lymphovascular control with diathermy is associated with a statistically higher short-term complication rate compared with ligaclip usage (ie 'permanent' ligation). Lymphocoeles are the principal complication and can result in delayed wound infection and breakdown. A small but statistical increase in operative time and wound length is likely to be related to registrar training.

Changing trends in the management of colorectal cancers and its impact on cancer waiting times.

OBJECTIVE: The aim of this study was to compare the differences in the presentation, management and waiting times for new colorectal cancer (CRC) patients over 5 years in a single metropolitan cancer centre. METHODS: A retrospective comparative study of new patients with CRC presenting in the years 1998 and 2003. The groups were compared for referral type, Dukes' stage, site, cancer waiting times and primary treatment. RESULTS: There were 72 new patients in 1998 and 77 in 2003. In 1998 33% were seen urgently and 28% as emergencies whereas in 2003 55% of patients were seen as urgent or target wait patients and 16% as emergencies. The 2-week target for urgent referrals was met in 50% of cases in 1998 and 90% in 2003. In 2003 a higher proportion of patients received adjuvant or neoadjuvant treatment. Stage at diagnosis was similar in both groups, except stage 'D' which was 21% in 1998 and only 12% in 2003. The 31-day Cancer Waiting Time (CWT) target from decision to treat to first treatment would have been met in 81% of cases in 1998 and 79% in 2003. The 62-day overall CWT target from referral to first treatment for urgent GP referrals would have been met in 46% of cases in 1998 and 57% in 2003. CONCLUSION: More CRC patients were referred urgently in 2003. Most, but not all of these were referred as target waits. The time taken for the patient's journey did not improve between the two cohorts, possibly in part, because more complex treatments are now provided. Further work and perhaps new thinking are needed in order to achieve Cancer Waiting Time targets.