Important surgical concepts and techniques in inguinal lymph node dissection

Penile cancer is a rare disease with significant physical and psychosocial morbidity. It has a propensity to spread to the inguinal lymph nodes where it can progress to the pelvis and beyond. Here, we present a contemporary review on the surgical management of the lymph nodes.

Appropriate management of the lymph nodes is critical, and has been shown to impact survival for these patients. Those with lower stage disease can achieve cure with inguinal lymph node dissection (ILND), whereas a multidisciplinary approach is required in those with more extensive disease. Tertiary referral center should be strongly considered. Advances in surgical techniques have allowed for improved outcomes and lower morbidity postoperatively. Modified ILND can be safely performed for those with nonpalpable nodes, whereas diagnostic sentinel node biopsy is a good alternative in centers of experience. Minimally invasive ILND has recently gained popularity with favorable results at short-term follow-up. For those with more advanced disease, the literature remains scarce with no high-level evidence as of yet.

Early upfront surgery appears the best way to approach men with early involvement of the inguinal lymph nodes, whereas systemic therapy is typically reserved for higher volume disease. Clinical trial enrollment continues to be a priority to garner more evidence-based recommendations for this aggressive malignancy.