Controversies in ilioinguinal lymphadenectomy for cancer of the penis

One of the most important aspects in oncology is the definition of clinically relevant subgroups of patients whose disease wil have different behavior to enable decision making about therapeutic methods. The appropriate management of regional adenopathy in patients with penile cancer has generated a number of controversies. Generally, clinical determination of the extent of local disease is difficult. About 50% of patients with node enlargement have no tumor on histologic examination, and 20% of patients with clinically negative nodes have micrometastases. Lymph node biopsies, including sentinel node biopsy, are of limited staging value. Patients with lesions that do not invade the corpora and who have no palpable nodes should be followed carefully at 2- to 3-month intervals after excision of the primary tumor. Those with persistent adenopathy should undergo superficial lymph node dissection first, and if positive nodes are found, bilateral deep node dissection should be performed. Bilateral inguinal and pelvic lymphadenectomy is recommended for patients with lesions invading the corpora with clinically negative or positive nodes because of the high incidence of lymph node metastases in such cases (Table 1). When adenopathy persists after excision of the primary tumor, we advocate first a limited pelvic dissection. If the pelvic nodes are negative or not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can be helpful in preoperative staging in patients with penile cancer. Potential areas of study include identification of better risk factors and improvement of preoperative staging methods. This goal is hampered by the fact that penile cancer is a rare finding.(ABSTRACT TRUNCATED AT 250 WORDS)