Surgical Advances in Inguinal Lymph Node Dissection

Lymphadenectomy (LND) for locally advanced penile cancer is often necessary in patients with suspected disease within the inguinal or pelvic lymph nodes because the results of systemic therapy are somewhat marginal. It has utility in staging, disease prognosis, and treatment in certain men because early dissection of involved lymph nodes improves survival. Despite its mainstay in the management of this disease, inguinal and pelvic lymph node dissection can be associated with significant postoperative complications and patient morbidity. Recent refinements in surgical technique, however, and appropriate patient selection can minimize these risks and lead to better short-term and long-term outcomes.

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For men with 2 or more positive ILNs or inguinal extracapsular extension (pN3), an ipsilateral or bilateral PLND is indicated for appropriate surgical treatment and staging.

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For men with 2 or more positive ILNs or inguinal extracapsular extension (pN3), an ipsilateral or bilateral PLND is indicated for appropriate surgical treatment and staging.

A summarized algorithm of the clinical indications for lymphadenectomy for penile carcinoma is provided in Fig. 2 .

The distal attachments of the rectus abdominis muscle to the pubic bone may sometimes be incised to allow for additional mobility of the flap. Doppler ultrasound also may be used to ensure adequate blood supply from the pedicle of the RAM flap. Last, the island of skin and subcutaneous tissue between the base of the flap and the recipient site is incised to the level of the external oblique aponeurosis. The apical portion of the flap is then tunneled to the groin defect and secured appropriately.

Patients with metastatic node-positive disease have a recurrence rate of 19%, so imaging of the chest, abdomen, and pelvis with CT, MRI, or PET-CT is recommended at 3-month to 6-month intervals for the first 2 years due to the risk of development of locoregional or distant metastatic disease. This should complement routine physical examination, and these patients may benefit from adjuvant radiation therapy or systemic chemotherapy.

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