Survival Outcomes of Penile Cancer Patients undergoing Primary Surgery: Experience from a Tertiary Cancer Care Centre...

Historically, the management of inguinal nodes in node-negative carcinoma penis has been a topic of debate. The chance of harboring micrometastasis in inguinal nodes in clinically node-negative patients is up to 25%. Dynamic sentinel node biopsy and elective inguinal lymph node dissection have flaws of false negativity and morbidity.

This is a retrospective study on patients with carcinoma penis treated between January 2010 and August 2019 who underwent upfront surgery for the disease. Patients who were clinically and radiologically node-negative underwent surgery for the primary disease only, and were kept under follow-up for nodal recurrence, while those with suspicious nodes clinically or radiologically underwent inguinal node dissection.

77 patients were included in the study. Of the 50 patients who were clinically and radiologically nodenegative and did not undergo nodal dissection or invasive nodal staging, 21 had recurrence. Of the 27 patients who had node dissection, 16 were pathologically negative. Nine out of 16 patients with pathologically node-negative and seven out of 11 patients with pathologically node positive disease had recurrence. The median Overall survival (OS) and the median Recurrence free survival (RFS) were 77 and 75 months, respectively. The median OS in nodal observation and pathologically nodenegative group were 92 and 79 months, respectively (p- 0.266). The median RFS in nodal observation and pathologically node-negative group were 90 and 74 months, respectively (p- 0.182).

Our series shows that in properly evaluated clinically and radiologically node negative patients kept under observation, OS and RFS are comparable with pathologically node-negative patients, opening a window for nodal observation, thus avoiding morbidities of ilioinguinal block dissection or invasive nodal staging.