When is this procedure indicated?
The indication for such surgery in urology exists in the following cases
- pT1, pT2 or pT3 stage penile cancer. In selected cases of cN0 patients, i.e. without clinically relevant lymph nodes, the sentilla lymph node approach may be indicated;
- Penile cancer with clinically relevant lymphadnopathies (stage cN1, cN2 and cN3).
Although inguinal lymph node invasion is considered an inauspicious factor, lymphadenectomy can be curative and give a five-year probability of cancer-specific survival in up to 70% of cases.
Finally, inguinal lymphadenectomy can also be a palliative intervention in patients with distant metastases. In fact, if metastatic inguinal lymph nodes are not removed, they can easily become infected, causing abscesses and inguinal ulcers.
How is it performed?
Inguinal lymphadenectomy is a delicate procedure, and due to the close relationship of the inguinal lymph nodes to the skin, it may require surgical reconstruction using skin grafts. Inguinal lymphadenctomy can be performed by open, laparoscopic, or robotic technique. It consists in the removal of all superficial and deep inguinal lymph nodes, located in the vicinity of femoral vessels. A drainage tube is left in place. It is often associated with parietal/total glandulectomy/penectomy surgery.
The post-operative stay is usually a few days (on average 4), and often the patient is discharged with the drainage tubes that will be removed in the outpatient clinic a few days later. Depending on the result of the histological examination of the inguinal lymphadenectomy, the patient will be initiated to a program of observation only (follow-up) or of mono or bilateral pelvic lymphadenectomy and adjuvant chemotherapy at the discretion of the treating oncologist (in cases of stage pN2 and pN3).
Lymphadenectomy can be complicated in 30-70% by leg and/or scrotal lymphedema, necrosis of any skin graft, wound infection, and deep vein thrombosis events.
In some cases (5-13%), lower extremity lymphedema may corniculate.