The Relationship between Characteristics of Inguinal Lymph Nodes and Pelvic Lymph Node Involvement in Penile Squamous Cell Carcinoma: A Single Institution Experience

Abstract

The number and diameter of inguinal lymph node metastases as well as extranodal extension are significantly associated with pelvic lymph node metastases. These variables should be considered to determine the need for pelvic lymph node dissection. Patients with no risk factors may be spared this dissection.

Current surgical management of penile cancer

“…59 Patients with pelvic nodal metastasis have a worse overall prognosis compared with patients with only inguinal nodal disease (5-year CSS: 71% vs 33.2%). 59 Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy, however, may improve outcomes in this patient population based on phase II trials.…”

Extent of pelvic lymph node dissection in penile cancer may impact survival

“…All patients had squamous cell carcinoma of the penis with unilateral inguinal LNM and pathological confirmation of pelvic nodes following PLND. The decision to perform PLND has changed over time in each contributing center, however, currently is based on the presence of two or more inguinal LNM, the presence of extranodal extension (ENE) or suspicious pelvic imaging [5,6,10]. The extent of the PLND was not standardized between the centers; however, it included external iliac, obturator and internal iliac nodes.…”

“…In case of pelvic nodal disease, historically very low 5-year survival rates have been reported [1][2][3][4][5]. In more recent times, however, combination of chemotherapy and appropriate surgical care has led to reported improvements in long-term outcomes in selected patients who present with more advanced disease [6].…”

“…Based on retrospective series, it is recommended that men with two or more metastatic inguinal nodes or extranodal extension (ENE) should undergo an ipsilateral PLND [7,8]. The boundaries of this dissection have been described as removal of lymphatic tissue between the bifurcation of the aorta, the genitofemoral nerve, prostate, bladder and the internal iliac artery, and the pelvic floor [5,9], although less extensive dissection of only external iliac and obturator lymph nodes has also been described [6].…”

“…The Kaplan-Meier estimated median OS was National Comprehensive Cancer Network (NCCN) guidelines recommend neoadjuvant chemotherapy in cN2-3 patients followed by surgery [8]. Long-term survival has been reported in patients with pelvic nodal metastasis treated with PLND and chemotherapy [6]. Therefore following chemotherapy, an adequate PLND may have therapeutic benefits rather than being merely a staging procedure.…”