Mariela R. Pow-Sang, MD, Victor Benavente, MD, Julio E. Pow-Sang, MD, Carlos Morante, MD, Luis Meza, MD, Mark Baker, MD, and Julio M. Pow-Sang, MD

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Institutional Experience

At the Instituto de Enfermedades Neoplasicas in Lima, Peru, 160 patients with the diagnosis of squamous cell carcinoma of the penis underwent bilateral IILND 6 weeks after excision of the primary penile lesion between June 1953 and July 2001. Surgical technique of the IILND involved one parallel incision 2 cm below the inguinal ligament extending below the pubic tubercle for an inguinal approach. The incision is deepened to the level of Scarpa's fascia. The superior and inferior skin flaps are raised and the lymph node dissection is begun superiorly 4 to 5 cm above the inguinal ligament. The medial and lateral dissection extends to the lymph nodes along the adductor longus and sartorius muscles. The inferior dissection extends across the apex of the femoral triangle at the level of the fascia lata. The greater saphenous vein is identified and divided. All tissues are dissected off the anterior and lateral aspects of the femoral vessels. The dissection proceeds superiorly and medially, freeing the entire package until its only attachments are deep to the inguinal ligament, and the lymph nodes are removed en bloc. A pelvis lymph node dissection is performed simultaneously through incision of the inguinal ligament. The external femoral artery and vein are identified, and all lymphatic tissue is freed from these structures. At the end of lymphadenectomy, the sartorius muscle is rotated over the femoral vessels, and it is anchored to the inguinal ligament.

Mean patient age was 54 years (range 21 to 78 years). Mean time from the appearance of lesion to treatment was 13 months (range 1 to 96 months). Phimosis was present in 42 (26%) of 160 patients. Penile cancer developed in the glans and prepuce in 76 patients (47.5%), in the glans in 36 (22.5%), in the glans, prepuce, and shaft of the penis in 34 (21%), in the prepuce in 10 (6%), and in the shaft in 4 (2%). Pathology was reviewed and patients were stratified retrospectively according to the 1997 TNM classification[38] and Broder's grading system.[74] Among these 160 patients, 100 tumors were classified as well differentiated, 45 as moderately differentiated, and 7 as poorly differentiated. The remaining 8 tumors could not be classified according to grade.

Lymph node metastasis was present in 6 (9%) of 68 patients without palpable adenopathy and in 66 (72%) of 91 patients with palpable adenopathy. Overall survival is shown in Fig 2. The 5-year survival rate for pN0, pN1, pN2, and pN3 disease was 92%, 100%, 68%, and 31%, respectively. With standard lymphadenectomy in 153 patients, flap necrosis occurred in 98 (64%), lower extremity lymphedema in 57 (37%), and lower extremity cellulitis in 9 (5%).

Figure 2.

Overall survival of patients with squamous cell carcinoma of the penis undergoing bilateral IILND.

Since July 2000, we have performed 7 modified inguinal lymphadenectomies, with frozen section study of the lymph nodes as described by Catalona.[63] None of these 7 patients had lymph node metastases. Flap necrosis developed in 1 patient, lymphedema in 3 patients, and delayed cellulitis in 2 patients.

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