Morbidity of Modified Prophylactic Inguinal Lymphadenectomy for Squamous Cell Carcinoma of the Penis

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002Morbidity of Modified Prophylactic Inguinal Lymphadenectomy for Squamous Cell Carcinoma of the Penis Timothy R. Coblentz and Dan Theodorescu Timothy R. CoblentzTimothy R. Coblentz and Dan TheodorescuDan Theodorescu View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64455-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Classic inguinal lymphadenectomy for penile cancer is associated with significant immediate and long-term sequelae limiting its use in the prophylactic setting. Preservation of the saphenous vein has been shown in the gynecological oncology literature to reduce the morbidity of inguinal lymphadenectomy. In addition, saphenous vein sparing coupled with thick skin flaps and limited lymphadenectomy for penile cancer has been associated with minimal morbidity. Reports on saphenous vein preservation in men undergoing inguinal lymphadenectomy are limited and, therefore, we reviewed our experience. Materials and Methods: We reviewed retrospectively 11 patients with stage pT1–T3 cN0 M0 grades I to III carcinoma of the penis or penile urethra who underwent bilateral inguinal lymphadenectomy with saphenous vein sparing and thick skin flaps between August 1995 and November 2001. Of the patients 1 underwent simultaneous penectomy and 10 had undergone a partial or total penectomy previously. Short-term and long-term postoperative complications were defined as minor—did not require significant medical intervention and included superficial skin edge sloughing, seroma and lymphocele, and major—skin edge or flap necrosis, wound infection, deep venous thrombosis or leg edema inhibiting return to pretreatment activities. Results: Mean followup was 9 months. The saphenous vein was preserved in 19 groins and ligated in 3. Simultaneous bilateral pelvic lymphadenectomy was performed in 5 patients. Nodal disease was found in 5 of 11 (45%) patients on pathological review. Minor short-term complications occurred in 8 of 22 (36%) groins, and major complications included deep venous thrombosis in 1 case and a small myocardial infarction in 1. There was no perioperative mortality. Lower extremity lymphedema requiring more than temporary (less than 6 months) support hose management did not occur in any patient. There were no inguinal recurrences during followup. Conclusions: Inguinal lymphadenectomy with saphenous vein sparing and thick skin flaps appears to offer excellent functional outcome in patients undergoing prophylactic bilateral inguinal lymphadenectomy for high risk disease. Early followup indicates that the local recurrence rate does not appear to increase compared to similar patients reported on in the literature treated with the classic dissection technique. References 1 : Penile cancer: relation of extent of nodal metastasis to survival. J Urol1987; 137: 880. Link, Google Scholar 2 : Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. Br J Urol1993; 72: 817. Crossref, Medline, Google Scholar 3 : Management of regional lymph nodes in penile carcinoma. Five-year results following therapeutic groin dissections. Urology1984; 24: 308. Crossref, Medline, Google Scholar 4 : Carcinoma of the penis: improved survival by early regional lymphadenectomy based on the histological grade and depth of invasion of the primary lesion. J Urol1995; 154: 1364. Link, Google Scholar 5 : Treatment of carcinoma of the penis: the case for primary lymphadenectomy. J Urol1986; 136: 38. Link, Google Scholar 6 : Analyses of 200 lymphadenectomies in patients with penile carcinoma. J Urol1991; 146: 330. Link, Google Scholar 7 : Morbidity following groin dissection for penile carcinoma. Br J Urol1993; 72: 941. Crossref, Medline, Google Scholar 8 : Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol1993; 149: 492. Link, Google Scholar 9 : Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol1996; 155: 1626. Link, Google Scholar 10 : Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology1984; 24: 312. Crossref, Medline, Google Scholar 11 : Anatomy and biopsy of sentinel lymph nodes. Urol Clin North Am1992; 19: 267. Crossref, Medline, Google Scholar 12 : Unreliability of sentinel lymph node biopsy for staging penile carcinoma. J Urol1980; 124: 734. Link, Google Scholar 13 : Cabanas approach: is sentinel node biopsy reliable for staging penile carcinoma?. Urology1986; 28: 278. Crossref, Medline, Google Scholar 14 : Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol1988; 140: 306. Link, Google Scholar 15 : Accurate staging of carcinoma of the penis in men with nonpalpable inguinal lymph nodes by modified inguinal lymphadenectomy. J Urol1996; 155: 560. Link, Google Scholar 16 : Long-term follow-up of men undergoing modified inguinal lymphadenectomy for carcinoma of the penis. Br J Urol1997; 79: 54. Crossref, Medline, Google Scholar 17 : TNM Classification of Malignant Tumors. New York: John Wiley & Sons, Inc.1997. Google Scholar 18 : Staging pelvic lymphadenectomy for localized carcinoma of the prostate: a comparison of 3 surgical techniques. J Urol1997; 157: 1337. Link, Google Scholar 19 : Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol1994; 151: 1244. Link, Google Scholar 20 : Preservation of the saphenous vein during inguinal lymphadenectomy decreases morbidity in patients with carcinoma of the vulva. Cancer2000; 89: 1520. Crossref, Medline, Google Scholar From the Departments of Urology and Molecular Physiology and Biological Physics, University of Virginia Health Sciences Center, Charlottesville, Virginia© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Patel A, Naghavi A, Johnstone P, Spiess P and Grass G (2022) Updates in the use of radiotherapy in the management of primary and locally-advanced penile cancerAsian Journal of Urology, 10.1016/j.ajur.2022.05.010, VOL. 9, NO. 4, (389-406), Online publication date: 1-Oct-2022. Marilin N, Master V, Pettaway C and Spiess P (2021) Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey studyUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2021.03.007, VOL. 39, NO. 7, (439.e9-439.e15), Online publication date: 1-Jul-2021. Nerli R, Sharma M, Patel P, Ghagane S, Patil S, Gupta P, Hiremath M and Dixit N (2021) Modified Inguinal Lymph Node Dissection in Groin-Negative Patients of Penile Cancer: Our ExperienceIndian Journal of Surgical Oncology, 10.1007/s13193-021-01285-w, VOL. 12, NO. 1, (229-234), Online publication date: 1-Mar-2021. Gu H, Liu G, Chen J, Li J, Zhang X, Liu Z and Tu H (2020) Proposal for modified inguinofemoral lymphadenectomy derived from investigation of anatomic distribution of sentinel and metastatic nodes in vulvar cancerJournal of Surgical Oncology, 10.1002/jso.26290, VOL. 123, NO. 2, (660-666), Online publication date: 1-Feb-2021. Dräger D and Schmidt S (2019) Wunddrainage nach inguinaler Lymphadenektomie bei malignen ErkrankungenWound drainage after inguinal lymphadenectomy in malignant diseasesDer Urologe, 10.1007/s00120-019-0920-7, VOL. 58, NO. 5, (555-558), Online publication date: 1-May-2019. Nabavizadeh R and Master V (2019) Minimally invasive approaches to the inguinal nodes in cN0 patientsCurrent Opinion in Urology, 10.1097/MOU.0000000000000588, VOL. 29, NO. 2, (165-172), Online publication date: 1-Mar-2019. Azizi M, Chipollini J, Peyton C, Cheriyan S and Spiess P (2019) Current controversies and developments on the role of lymphadenectomy for penile cancerUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2018.08.017, VOL. 37, NO. 3, (201-208), Online publication date: 1-Mar-2019. Sheetz T and Lee C (2018) Frailty and geriatric assessment in urologic oncologyCurrent Opinion in Urology, 10.1097/MOU.0000000000000501, VOL. 28, NO. 3, (233-242), Online publication date: 1-May-2018. Tobias-Machado M and Moschovas M (2018) Inguinal Lymphadenectomy Complications in Robotic Urologic Surgery, 10.1007/978-3-319-62277-4_32, (305-310), . Chenam A and Jafri S (2018) Complications of Inguinal Lymphadenectomy Malignancies of the Groin, 10.1007/978-3-319-60858-7_4, (39-53), . Tobias-Machado M, Moschovas M and Ornellas A (2018) History of Minimally Invasive Inguinal Lymphadenectomy Malignancies of the Groin, 10.1007/978-3-319-60858-7_1, (1-7), . Leone A, Diorio G, Pettaway C, Master V and Spiess P (2017) Contemporary management of patients with penile cancer and lymph node metastasisNature Reviews Urology, 10.1038/nrurol.2017.47, VOL. 14, NO. 6, (335-347), Online publication date: 1-Jun-2017. Nam J, Lee D, Park S, Kam S, Lee K, Kim T, Kim T, Oh C, Park H and Kim T (2017) Clinicopathologic Characteristics and Treatment Outcomes of Penile CancerThe World Journal of Men's Health, 10.5534/wjmh.2017.35.1.28, VOL. 35, NO. 1, (28), . Shabbir M, Kayes O and Minhas S (2014) Challenges and controversies in the management of penile cancerNature Reviews Urology, 10.1038/nrurol.2014.307, VOL. 11, NO. 12, (702-711), Online publication date: 1-Dec-2014. Thomson D, Sadideen H, Furniss D and Furniss D (2014) Wound drainage following groin dissection for malignant disease in adults Cochrane Database of Systematic Reviews, 10.1002/14651858.CD010933 Koifman L, Hampl D, Koifman N, Vides A and Ornellas A (2013) Radical Open Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Technique, Early Complications and Late OutcomesJournal of Urology, VOL. 190, NO. 6, (2086-2092), Online publication date: 1-Dec-2013. Mannweiler S, Sygulla S, Tsybrovskyy O, Razmara Y, Pummer K and Regauer S (2013) Clear-Cell differentiation and lymphatic invasion, but not the revised TNM classification, predict lymph node metastases in pT1 penile cancer: A clinicopathologic study of 76 patients from a low incidence areaUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2012.01.017, VOL. 31, NO. 7, (1378-1385), Online publication date: 1-Oct-2013. Ercole C, Pow-Sang J and Spiess P (2013) Update in the surgical principles and therapeutic outcomes of inguinal lymph node dissection for penile cancerUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2011.02.020, VOL. 31, NO. 5, (505-516), Online publication date: 1-Jul-2013. Zhou X, Zhang J, Zhang J, Zhou S and Yuan X (2013) Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma and Genital Malignancy: A Preliminary ReportJournal of Endourology, 10.1089/end.2012.0437, VOL. 27, NO. 5, (657-661), Online publication date: 1-May-2013. Ercole C and Spiess P (2013) Surgical Concepts and Considerations of Inguinal Lymph Node Dissection for Penile Cancer Penile Cancer, 10.1007/978-1-62703-367-1_6, (91-106), . Chaux A and Cubilla A (2012) Stratification systems as prognostic tools for defining risk of lymph node metastasis in penile squamous cell carcinomasSeminars in Diagnostic Pathology, 10.1053/j.semdp.2011.08.006, VOL. 29, NO. 2, (83-89), Online publication date: 1-May-2012. Sharp D and Angermeier K (2012) Surgery of Penile and Urethral Carcinoma Campbell-Walsh Urology, 10.1016/B978-1-4160-6911-9.00035-9, (934-955.e3), . Pettaway C, Lance R and Davis J (2012) Tumors of the Penis Campbell-Walsh Urology, 10.1016/B978-1-4160-6911-9.00034-7, (901-933.e9), . Guimarães G, Rocha R, Zequi S, Cunha I and Soares F (2011) Penile Cancer: Epidemiology and TreatmentCurrent Oncology Reports, 10.1007/s11912-011-0163-2, VOL. 13, NO. 3, (231-239), Online publication date: 1-Jun-2011. Malone P, Thomas J and Blick C (2010) A tie-over dressing for graft application in distal penectomy and glans resurfacing: the TODGA techniqueBJU International, 10.1111/j.1464-410X.2010.09576.x, VOL. 107, NO. 5, (836-840), Online publication date: 1-Mar-2011. Heyns C, Fleshner N, Sangar V, Schlenker B, Yuvaraja T and van Poppel H (2010) Management of the Lymph Nodes in Penile CancerUrology, 10.1016/j.urology.2010.03.001, VOL. 76, NO. 2, (S43-S57), Online publication date: 1-Aug-2010. Margulis V and Sagalowsky A (2010) Penile Cancer: Management of Regional Lymphatic DrainageUrologic Clinics of North America, 10.1016/j.ucl.2010.04.009, VOL. 37, NO. 3, (411-419), Online publication date: 1-Aug-2010. Yao K, Tu H, Li Y, Qin Z, Liu Z, Zhou F and Han H (2010) Modified Technique of Radical Inguinal Lymphadenectomy for Penile Carcinoma: Morbidity and OutcomeJournal of Urology, VOL. 184, NO. 2, (546-552), Online publication date: 1-Aug-2010. Sawan S, Mugnai R, de Barros Lopes A, Hughes A and Edmondson R (2009) Lower-Limb Lymphedema and Vulval Cancer: Feasibility of Prophylactic Compression Garments and Validation of Leg Volume MeasurementInternational Journal of Gynecologic Cancer, 10.1111/IGC.0b013e3181a8446a, VOL. 19, NO. 9, (1649-1654), Online publication date: 1-Nov-2009. Caso J, Rodriguez A, Correa J and Spies P (2009) Update in the management of penile cancerInternational braz j urol, 10.1590/S1677-55382009000400003, VOL. 35, NO. 4, (406-415), Online publication date: 1-Aug-2009. Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A and Hakenberg O (2009) Lymphadenectomy in the Surgical Management of Penile CancerEuropean Urology, 10.1016/j.eururo.2009.02.021, VOL. 55, NO. 5, (1075-1088), Online publication date: 1-May-2009. Spiess P, Hernandez M and Pettaway C (2008) Contemporary inguinal lymph node dissection: minimizing complicationsWorld Journal of Urology, 10.1007/s00345-008-0324-6, VOL. 27, NO. 2, (205-212), Online publication date: 1-Apr-2009. Josephson D, Jacobsohn K, Link B and Wilson T (2009) Robotic-assisted Endoscopic Inguinal LymphadenectomyUrology, 10.1016/j.urology.2008.05.060, VOL. 73, NO. 1, (167-170), Online publication date: 1-Jan-2009. Stancik I, Höltl W, De Santis M and Jakse G (2009) Peniskarzinom Uroonkologie, 10.1007/978-3-642-01382-9_27, (739-747), . Heyns C and Theron P (2008) Evaluation of dynamic sentinel lymph node biopsy in patients with squamous cell carcinoma of the penis and palpable inguinal nodesBJU International, 10.1111/j.1464-410X.2008.07628.x, VOL. 102, NO. 3, (305-309), Online publication date: 1-Aug-2008. Blana A, Denzinger S, Lenhart M, Wieland W and Ganzer R (2007) Treatment of a recurrent inguinal lymphocele in a penis cancer patient by lymphography and selective ligation of lymphatic vesselsInternational Journal of Urology, 10.1111/j.1442-2042.2006.01713.x, VOL. 14, NO. 5, (450-451), Online publication date: 1-May-2007. Meijer R, Boon T, van Venrooij G and Wijburg C (2007) Long-Term Follow-up After Laser Therapy for Penile CarcinomaUrology, 10.1016/j.urology.2007.01.023, VOL. 69, NO. 4, (759-762), Online publication date: 1-Apr-2007. Höltl W, Stancik I, De Santis M and Jakse G (2007) Peniskarzinom Uroonkologie, 10.1007/978-3-540-33848-2_23, (611-618), . Sarin R, Tongaonkar H and Engineer R The Clinical Management of Penile Cancer Urological Cancers in Clinical Practice, 10.1007/978-1-84628-507-3_11, (231-261) Naumann C, van der Horst C, Volkmer B, Kurtz F, Martinéz Portillo F, Seif C, Hautmann S, Braun P, Hautmann R and Jünemann K (2006) Der Einfluss des T-Stadiums auf das Metastasierungsrisiko des Peniskarzinoms: T1 vs. T2The influence of the T stage on the risk of metastasis of penis cancer: T1 vs. T2Der Urologe, 10.1007/s00120-006-1160-1, VOL. 45, NO. 11, (1424-1430), Online publication date: 1-Nov-2006. Noble M Malignancies of the Penis and Urethra Operative Urology at the Cleveland Clinic, 10.1007/978-1-59745-016-4_42, (415-430) KROON B, LONT A, VALDÉS OLMOS R, NIEWEG O and HORENBLAS S (2018) MORBIDITY OF DYNAMIC SENTINEL NODE BIOPSY IN PENILE CARCINOMAJournal of Urology, VOL. 173, NO. 3, (813-815), Online publication date: 1-Mar-2005. Sarin R, Tongaonkar H and Engineer R (2005) The Clinical Management of Penile Cancer Urological Cancers, 10.1007/1-84628-015-X_24, (283-298), . Kroon B, Horenblas S and Nieweg O (2004) Contemporary management of penile squamous cell carcinomaJournal of Surgical Oncology, 10.1002/jso.20170, VOL. 89, NO. 1, (43-50), Online publication date: 1-Jan-2005. NELSON B, COOKSON M, SMITH J and CHANG S (2018) COMPLICATIONS OF INGUINAL AND PELVIC LYMPHADENECTOMY FOR SQUAMOUS CELL CARCINOMA OF THE PENIS: A CONTEMPORARY SERIESJournal of Urology, VOL. 172, NO. 2, (494-497), Online publication date: 1-Aug-2004. Bouchot O, Rigaud J, Maillet F, Hetet J and Karam G (2004) Morbidity of Inguinal Lymphadenectomy for Invasive Penile CarcinomaEuropean Urology, 10.1016/j.eururo.2003.12.003, VOL. 45, NO. 6, (761-766), Online publication date: 1-Jun-2004. Stancik I and H??ltl W (2003) Penile cancer: review of the recent literatureCurrent Opinion in Urology, 10.1097/00042307-200311000-00008, VOL. 13, NO. 6, (467-472), Online publication date: 1-Nov-2003. Volume 168Issue 4 Part 1October 2002Page: 1386-1389 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordspenile neoplasmslymph nodeslymph node excisiontreatment outcomeMetricsAuthor Information Timothy R. Coblentz More articles by this author Dan Theodorescu More articles by this author Expand All Advertisement PDF downloadLoading ...