Early versus delayed lymph-node dissection versus no lymph-node dissection in carcinoma of the penis

Assessment of the inguinal lymph nodes for metastases in patients with penile cancer is inaccurate. About 50 per cent of patients with node enlargement have no tumor on histologic examination, and 20 per cent 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 after excision of the primary tumor at 2- to 3-month intervals. If compliance with such a follow-up is doubtful, bilateral superficial groin-node dissection seems appropriate. Those with persistent adenopathy should undergo superficial lymph-node dissection first, and if positive nodes are found, bilateral deep-node dissection should then 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. Where adenopathy persists after excision of the primary tumor, we advocate first limited pelvic dissection. If the pelvic nodes are negative or are not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can improve preoperative staging in patients with penile cancer.