Inguinal Lymphadenectomy Assessment Associated with Penile Carcinoma Undergone New Strategies for Nodal Staging

摘要

Penile carcinoma is an uncommon urological tumour and provides an opportunity for curation on early stage of the disease. Nodal metastases are one of the most important prognostic factors for survival although detection of inguinal adenopathies could be related with an inflammatory or infectious etiology. A suspicion of bilateral metastasic nodal involvement should be taken with caution. Radical inguinal lymphadenectomy has been associated to a great deal of complications. Several anatomical studies have reported the true lymphatic drainage pathways in order to reduce the area of groin dissection. Nonetheless, a prophylactic modified inguinal lymphadenectomy should not be a systematic surgical procedure in all patients due to morbidity and questioned usefulness when there are not nodal metastasis. Classical imaging studies have a limited contribution to the diagnosis of lymph node metastasis. Nowadays, lymph node involvement may be diagnosed both minimally invasive and noninvasive techniques, such as dynamic sentinel lymph node biopsy in intermediate and high risk patients with nonpalpable lymph nodes, and fine needle aspiration biopsy in cases with palpable nodes. Their high effectiveness has facilitated the radical pelvic or inguinal lymphadenectomy that is only performed when there is histological confirmation of nodal involvement. A new video endoscopic technique has been developed at present to reduce postoperative complications although prospective studies are needed to assess outcomes. The appearance of adenopathies after surgical treatment of the primary tumour could be supported at the same guidelines.An inguinal lymphadenectomy should be carried out in selected patients to support a benefit on early stages with an extended survival.