Ilioinguinal Lymph Node Dissection

Inguinal lymphadenopathy in patients with penile cancer is common but may be the result of infection rather than neoplasm. If palpable enlarged lymph nodes persist three or more weeks after removal of the infected primary lesion and a course of antibiotic therapy, lymphadenectomy should be considered.

In cases of proven regional inguinal lymph node metastasis (fine needle aspiration cytology or biopsy) without evidence of distant spread, bilateral ilioinguinal dissection is the treatment of choice. Radiation therapy may be an alternative in patients who are not surgical candidates. Postoperative irradiation can decrease incidence of inguinal recurrences. Because of the high incidence of microscopic node metastases, elective adjunctive inguinal dissection of clinically uninvolved (negative) lymph nodes in conjunction with amputation is often used for patients with poorly differentiated tumours. However, lymphadenectomy can carry substantial morbidity, such as infection, skin necrosis, wound breakdown, chronic oedema, and even a low, but finite, mortality rate. The impact of prophylactic lymphadenectomy on survival is not known. For these reasons, there are varying opinions on its use.

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