Role of lymphadenectomy in carcinoma of the penis

Approximately 20 per cent of patients with invasive carcinoma of the penis who present without lymphadenopathy have occult lymph node metastases, and many of those treated by excision of the primary tumor alone ultimately die of cancer despite attempts at careful follow-up. Therefore, bilateral ilioinguinal lymphadenectomy, using modern techniques to reduce morbidity, is recommended as the preferred management for medically fit patients with clinically negative nodes, as well as for those with clinically positive nodes. In patients with clinically negative nodes who decline lymphadenectomy, sentinel node biopsy is also a legitimate option, although false-negative results may be obtained. Sentinel node biopsy should not be used to determine whether lymphadenectomy is indicated in patients with clinically positive nodes.