[Carcinoma of the penis. What to do with the regional lymph nodes?]

From 1982 to 1990, we diagnosed and treated 23 cases of squamous cell carcinoma of the penis. The minimum follow-up was 3 years (range 3-8 years; mean 4 years). Special emphasis was placed on the exact staging of the tumor according to the TNM classification, above all in relation to inguinal and iliac lymph node involvement, which indicates the choice of treatment and the prognosis. At the time of diagnosis, 14 patients (60.8%) had palpable inguinal lymph nodes. This was reduced to 10 patients after a 3-6 week course of antibiotic therapy. Treatment of the primary lesion is usually by partial amputation of the penis, which enables us to determine the pathological stage and the histological grade of the tumor and, consequently, our approach to the regional lymph nodes. Regional lymphadenectomy was performed early in 11 cases and delayed in 7 cases; i.e., when pathological nodes were palpable in the groin. Four patients (36.3%) had positive nodes in the first group and 6 (85.7%) in the second group. Forty percent had bilateral lymph node involvement. Overall the surgical technique carried a morbidity rate of 38.8% for skin necrosis and 33.3% for localized infections, which delayed healing but required no plastic surgery. Inguinal lymph node involvement is a major prognostic factor: when negative, our 3-year survival rate was 87.5%, which dropped to 40% when positive, despite lymphadenectomy. Currently, in relatively young patients with high stage and grade tumor, our approach is to do early bilateral ilioinguinal lymphadenectomy. Radical dissection carries an acceptable morbidity and mortality today and can benefit patients with positive nodes that may be undetected even by the best methods for clinical staging.