(1)
Norfolk and Norwich University Hospital, Norwich, UK
Introduction
Open radical inguinal lymphadenectomy is the current gold standard operation to treat inguinal lymph node metastasis in penile cancer. Though it is an oncologically effective surgery, the complications rates are still very high between 31% and 68% spurring various technical modifications.
Open modified radical inguinal lymphadenectomy is one such that involves reduced field of dissection and preservation of saphenous vein. This modification reduces wound related complication substantially from 50% to 15% whilst maintaining the same oncological safety as Open radical inguinal lymphadenectomy.
Open modified superficial inguinal lymphadenectomy is used as a staging tool in some centers without access to dynamic sentinel node biopsy. In this procedure only the superficial group of inguinal lymph nodes are removed as a diagnostic procedure and patients have completion Open radical inguinal lymphadenectomy if any of the lymph nodes are positive.
The more standard contemporary diagnostic test is Dynamic Sentinel Node Biopsy where the “first” (sentinel) lymph nodes draining the penis are removed and examined for metastasis. If the sentinel nodes are positive patient will proceed to radical inguinal lymph node dissection.
Indications for Open Radical Inguinal Lymphadenectomy
- 1.
Penile cancer with palpable inguinal lymph nodes
- 2.
Positive lymph nodes by sentinel node biopsy or Open modified superficial inguinal lymphadenectomy
Surgical Anatomy
The groin (inguinal and femoral) lymph nodes are present in two groups: superficial and deep. Superficial lymph nodes are present below the inguinal ligament, located deep under Camper’s (superficial fatty layer of the superficial fascia) fascia and are six to ten in number. The deep inguinal lymph nodes are located below the cribriform fascia (fascia covering the saphenous opening) and on the medial side of the femoral vein (Fig. 18.1). There are about 3–5 of these nodes. Cloquet’s node is the name of the top-most deep inguinal lymph node, which is located below the inguinal ligament in the femoral canal. The femoral triangle is bound by inguinal ligament superiorly, adductor longus muscle medially and Sartorius muscle laterally (Fig. 18.2).
