title: The development of a supraregional network for the management of penile cancer.
abstract: BACKGROUND
  Although its incidence is increasing, penile cancer remains a rare disease in the UK. In view of this low volume, the National Institute for Clinical Excellence recommended that treatment is centralised in a limited number of centres arranged as supraregional networks.  The aim of this centralisation is to allow the best standardised treatment for the primary tumours and nodal disease, thereby avoiding under or overtreatment. In this paper we review the formation and functioning of our network in the East Midlands.
  
  
  METHODS
  Data were collected up to August  2010 from our prospective penile network database since its inception in 2005. These data were analysed to see our workload, patterns of referral and surgeries performed over this time period.
  
  
  RESULTS
  The structure and function of the East Midlands network are described. There has been  an increase in the number of cases discussed since its formation. There has also been a trend towards more conservative surgery, both of the primary tumour and of nodal management. Between September 2009 and August 2010, 16 glansectomies were performed versus 5 total and 9 partial penectomies.  The same period saw 18 dynamic sentinel lymph node biopsies against 7 bilateral and 3 unilateral superficial groin dissections. There was a very high patient satisfaction rate, with patients feeling they had good support and information.
  
  
  CONCLUSIONS
  On reviewing the literature it can  be clearly seen that supraregional networks have led to a decrease in overtreatment and better recognition of the need to manage lymph node status optimally. Our network has demonstrated the trend toward conservative surgery and sentinel node biopsy. The formation of supraregional networks  with a multidisciplinary approach will facilitate high volume centres that will offer optimal surgical therapy and also allow recruitment into studies and new chemotherapeutic regimens. It will also allow better data collection to aid clinical studies that hopefully will also demonstrate better  outcomes.
authors.affiliation: Barts and The London NHS Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: J C
authors.initials: JC
authors.lastname: Goddard
authors.forename: T R
authors.initials: TR
authors.lastname: Terry
authors.forename: D J
authors.initials: DJ
authors.lastname: Summerton
mesh_terms: D004739:England; D006801:Humans; D008297:Male; D008485:Medical Audit; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction; D010412:Penile Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration*; D016526:Workload / Q000706:statistics & numerical data