The Role of Ilioinguinal Lymphadenectomy and Significance of Histological Differentiation in Treatment of Carcinoma of the Penis

Abstract

We reviewed retrospectively the medical records of 58 patients treated for squamous cell carcinoma of the penis who were followed for more than 3 years or until they died. Tissue sections from all patients were reviewed. Of 15 patients with stage I disease 11 underwent partial penectomy, and 4 underwent partial penectomy and immediate ilioinguinal lymphadenectomy; none died of cancer. Nine patients with stage II and 9 with stage III disease underwent partial or total penectomy and immediate ilioinguinal lymphadenectomy, and 5-year survival was 100 and 75%, respectively. Of 20 patients with clinical stage II disease who did not undergo immediate ilioinguinal lymphadenectomy 18 had metastasis to the groin. Of these 18 patients 12 underwent delayed ilioinguinal lymphadenectomy but only 1 survived more than 5 years. We evaluated the possible significance of the degree of histological differentiation of the primary tumor to the course of the disease. Of the 23 cases of carcinoma in situ or well differentiated disease only 1 became metastatic, while of the 35 cases of moderately to poorly differentiated disease 31 metastasized to the groin. Vascular invasion of cancer cells in the primary tumor was another indicator for poor prognosis.

Predicting Cancer Progression in Patients with Penile Squamous Cell Carcinoma: The Importance of Depth of Invasion and Vascular Invasion

“…This approach has been successful (8,14,21,(23)(24). Lopes found that superficially invasive (1 to 5 mM) grade 1 or 2 tumors infrequently rarely metastasized (1 of 24) while deeply invasive ( more than 5 mM) and Grade 3 tumors usually metastasized (43 of 52) (24).…”

Surgical Management of Squamous Cell Carcinoma of the Penis

“…8,9 In addition to tumor staging, recent reports by Fraley, by Solsona, and by McDougal document the importance of tumor grade in the prognosis of penile cancers. 5,6,10 There is general consensus that patients presenting with superficial grade 1 lesions and palpably negative inguinal nodes may be followed expectantly. Similarly, there has been general agreement that patients with primary tumors of any stage and potentially resectable inguinal nodes which remain enlarged following a course of antibiotic therapy should undergo inguinal or ilioinguinal lymphadenectomy.…”

“…5,6,13,14 Unreliable patients or others who cannot be followed adequately are best served by prompt inguinal lymphadenectomy. Considerable debate has ensued over the years regarding immediate or delayed lymphadenectomy in other patients with clinically negative groins.…”

“…12,15,16,17 However, recent series support immediate inguinal lymphadenectomy in these cases, citing ultimate mortality rates of up to 20 per cent in patients who are followed until they develop clinically positive nodes before undergoing inguinal exploration. 5,6,12,15,16,17 It is clear that in many of these patients, a window of opportunity to provide a cure has been lost.…”

“…Metastasis to the pelvic nodes in the absence of inguinal node metastases is an extremely rare event and has not been observed in many modern series. 5,14,23 In the setting of negative superficial and deep inguinal lymphadenectomies and a negative pelvic CT scan, pelvic lymphadenectomy is not required.…”