Minimally Invasive Management of Inguinal Lymph Nodes in Penile Cancer: Recent Progress and Remaining Challenges

Area of Science:

• Oncology
• Surgical Oncology
• Urology

Background:

• Accurate diagnosis of occult inguinal lymph node metastasis in invasive penile squamous cell carcinoma (PSCC) remains a clinical challenge.
• Conventional open modified/superficial inguinal lymph node dissection (ILND) is associated with substantial perioperative complications.

Purpose of the Study:

• To review the evolution and compare the efficacy of dynamic sentinel lymph node biopsy (DSLNB) and minimally invasive inguinal lymph node dissection (ILND) for nodal staging in PSCC.
• To discuss the advantages, drawbacks, and future perspectives in managing inguinal lymph nodes in PSCC patients.

Main Methods:

• Review of current literature on DSLNB and minimally invasive ILND techniques for penile cancer.
• Comparative analysis of diagnostic accuracy, morbidity, and outcomes associated with different nodal staging and management strategies.

Main Results:

• DSLNB demonstrates high diagnostic accuracy and lower morbidity compared to open ILND for clinically node-negative patients.
• Laparoscopic and robotic-assisted ILND offer improved outcomes regarding wound infections and postoperative pain compared to open ILND.
• Minimally invasive ILND shows promising results for managing clinically palpable inguinal lymph nodes.

Conclusions:

• DSLNB is the preferred method for nodal staging in node-negative invasive PSCC, despite limited current utilization.
• Minimally invasive ILND techniques are valuable alternatives for nodal staging and treatment in PSCC.
• Variability in nodal staging and treatment practices is expected due to the rarity of PSCC and lack of prospective studies.