TITLE:
Inguinal Lymphadenectomy Assessment Associated with Penile Carcinoma Undergone New Strategies for Nodal Staging
AUTHORS:
Victor J. Ovejero Gomez, L. Martin Cuesta, F. Martinez Bretones, T. Gallego Bellido, L. A. Asensio Lahoz, J. Villalba Torre, A. Ingelmo Setien, J. M. Bajo Arenas
KEYWORDS:
Carcinoma, Penis, Surgical Treatment, Lymphadenectomy, Nodal Staging
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.7,
July
16,
2014
ABSTRACT:
Penile carcinoma is an uncommon urological
tumour and provides an opportunity for curation on early stage of the disease.
Nodal metastases are one of the most important prognostic factors for survival
although detection of inguinal adenopathies could be related with an
inflammatory or infectious etiology. A suspicion of bilateral metastasic nodal
involvement should be taken with caution. Radical inguinal lymphadenectomy has
been associated to a great deal of complications. Several anatomical studies
have reported the true lymphatic drainage pathways in order to reduce the area
of groin dissection. Nonetheless, a prophylactic modified inguinal lymphadenectomy
should not be a systematic surgical procedure in all patients due to morbidity
and questioned usefulness when there are not nodal metastasis. Classical
imaging studies have a limited contribution to the diagnosis of lymph node
metastasis. Nowadays, lymph node involvement may be diagnosed both minimally
invasive and noninvasive techniques, such as dynamic sentinel lymph node biopsy
in intermediate and high risk patients with nonpalpable lymph nodes, and fine
needle aspiration biopsy in cases with palpable nodes. Their high effectiveness
has facilitated the radical pelvic or inguinal lymphadenectomy that is only
performed when there is histological confirmation of nodal involvement. A new
video endoscopic technique has been developed at present to reduce postoperative
complications although prospective studies are needed to assess outcomes. The
appearance of adenopathies after surgical treatment of the primary tumour could
be supported at the same guidelines.An inguinal
lymphadenectomy should be carried out in selected patients to support a benefit
on early stages with an extended survival.