Cancer penis evaluation of role of prophylactic inguinal lymph nodes dissection

Prabhat B. Nichkaode; Rajendra Agrawal; Sayali Kulkarni

doi:10.18203/2349-2902.isj20173382

Authors

Prabhat B. Nichkaode Department of Surgery, Chandulal Chandrakar Memorial Medical College, Kachandur, Durg-490024, Chhattisgarh, India
Rajendra Agrawal Department of Surgery, Chandulal Chandrakar Memorial Medical College, Kachandur, Durg-490024, Chhattisgarh, India
Sayali Kulkarni Department of Gynaecology and Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20173382

Keywords:

Inguinal node, Lymph node dissection, Morbidity, Outcome, Penile cancer

Abstract

Background: Incidence of penile cancer is considerably variable across the globe; this disease is uncommon in the western world. But it is not uncommon to see the disease in Indian subcontinent. Also, it is not uncommon to see Penile growths with palpable unilateral or bilateral lymph nodes. In this retrospective observational study, we would like to present our data of 31 cases of Penile cancer with variable presentations, in terms of palpable groin lymph nodes. FNAC from palpable lymph nodes may not be diagnostic of metastasis. It is said that battle of cancer penis is either won or lost depends on how you deal with groin. It is a clear understanding that in presence of positive groin nodes Lymphadenectomy is the choice of treatment but it is unclear, how to deal with negative groin? In this study we present experience, in terms of deal with the groin lymph nodes aggressively, even when they not palpable for a better outcome after balancing the morbidity of the procedure. Aim was to evaluate the role of early prophylactic inguinal node dissection in patients with squamous cell cancer of Penis.

Methods: This retrospective observational study was carried out at tertiary care teaching institute from 2003 till 2012. The clinical, investigational, operative, pathology details and follow-up data were collected from patient records.

Results: Study showed data of 47 patients treated during the period from 2003 to 2012 and included 31 patients in this study, 21 patients (67.74%) presented with palpable inguinal nodes at the time of primary presentation. FNAC from these lymph nodes could prove metastasis, only in 16 patients (76.19 %). 5 patients (23.80) on FNAC had no metastasis. Remaining 10 patients were without lymph node enlargement at the time of primary presentation. Patients presented without palpable lymph nodes were offered modified inguinal block dissection. Histology showing 8 nodes positive for metastatic disease. And were FNAC was negative 4 (80 %) out of 5 patients with negative nodes shown positive for metastasis.

Conclusions: This retrospective observational study concludes with fact that palpable lymph nodes in the groin, is no doubt an indication for Inguinal node dissection but even when nodes are negative on FNAC or not palpable then prophylactic lymph nodes dissection should be undertaken. Delay in inguinal lymphadenectomy in non-palpable nodes you may lose the battle on cancer penis, as many reports say that, delayed lymphadenectomy has a strong impact on the survival. The only drawback with prophylactic lymph node dissection is the associated morbidity. But with modified procedures this can be very well minimized.

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References

Algaba F, Horenblas S, Piva GP, Solsona E, Windahl T. EAU guidelines on penile cancer. Eu Urol. 2002;42(3):199-203.

Horenblas S. Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection. BJU Int. 2001;88:473-83.

ENCR (European network of cancer registries). Eurocim version 4.0. European incidence database V.2.2 (1999) Lyon IARC, 2001. Available at: http:/www.encr.com.fr/encr_EUROCIMI.htm

Reddy CR, Raghavaiah NV, Mouli KC. Prevalence of carcinoma of penis with special reference to India. Int.Surg. 1975;60:474-6.

Penile cancer (Internet) 2009 (cited 2014 September 10) Available at: http://www.indiacancersurgerysite.com/penile-cancer-treatment-india.html.

Dillner J, von Krogh G, Horenblas S, Meijer CJ. Etiology of squamous cell carcinoma of penis. Scand J Urol Nephrol. 2000;205:189-93.

Ornellas AA, Seixas AL, Marota A, Wisnescky A, Campos F, de Moraes JR. Surgical treatment of invasive squamous cell cancer of penis; retrospective analysis of 350 cases. J Urol. 1994;151:1244-9.

Abi-Aad AS, De Kernion JB. Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am. 1992;19:319-24.

Rangabashyam N, Gnanaprakasam D, Meyyappan P, Vijayalakshmi SR, Thiruvadanam BS. Carcinoma of penis. Review of 214 cases. J R Coll Surg Edinb. 1981;26:104-9.

Ravi R. Morbidity following groin dissection for penile cancer. Br J Urol. 1993;126:108-10.

Saisorn I, Lawrentschuk N, Leewansangtong S, Bolton DM. Fine-needle aspiration cytology predicts inguinal lymph node metastasis without antibiotic pretreatment in penile carcinoma. BJU Int. 2006;97:1225-8.

Gursel EO, Georgountzos C, Uson AC, Melicow MM, Veenema RJ. Penile cancer: clinicopathologic study of 54 cases. J Urol. 1973;1:569-573.

Ornellas AA, Seixas AL, De Moraes JR. Analysis of 200 lymphadenectomies in patients with penile carcinoma. J Urol. 1991;146:330-2.

Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of Penile cancer. Eur Urol. 2009;55:1075-88.

Ravi R. Correlation between the extent of nodal involvement and survival following groin dissection for carcinoma of the penis. BJU International. 1993;72(5):817-9.

Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol. 1988;140:306-10.

Bevan-Thomas R, Slaton JW, Pettaway CA. Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M.D. Anderson cancer center experience. J Urol. 2002;167:1638-42.

Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G. Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol. 2004;45:761-6.

Horenblas S, Van Tinteren H, Delemarre JF, Moonen LM, Lustig V, Van Waardenburg EW. Squamous cell carcinoma of the penis III. Treatment of regional lymph nodes. J Urol. 1993;149:492-7.

Pettaway CA,Lance RS, Davis JW. Campbell-Walsh Urol. Philadelphia: Elsevier-Saunders; Tumors of the penis In Wein AJ (editor); 2012:901-33.

Leijte JA, Horenblas S. Inguinal metastasis in penile cancer: diagnosis and management. Eau-ebu Update Series. 2007;5(4):145-52.

Graafland NM, Teertstra HJ, Besnard AP, van Boven HH, Horenblas S. Identification of high risk pathological node positive penile carcinoma: value of preoperative computerized tomography imaging, J Urol. 2011;185:881-7.

Tabatabaei S, Harisinghani M, McDougal WS. Regional lymph node staging using Lymphotropic nanoparticle enhanced MRI with ferumoxtran-10 in patients with penile cancer. J Urol. 2011;174;923-7.

Pandey D, Mahajan V, Kannan RR, Prognostic factors in carcinoma penis. J Surg Oncol. 2006;93:133-8.

Omellas AA, Nobrega BL, Wei Chin E. Prognostic factors in invasive squamous cell carcinoma of penis analysis of 196 patients treated at the Brazilian National Cancer Institute. J Urol. 2008;180:1354-59.

Protzel C, Knoedel J, Wolf E, Kleist B, Poetsch M, Giebel J. Prognostic parameters of penis carcinoma. Der Urologe A. 2007;46:1162.

Protzel C, Kakies C, Kleist B, Poetsch M, Giebel J. Down- regulation of the metastasis suppressor protein KAI1/ CD82 correlates with occurrence of metastasis, prognosis and presence of HPV DNA in human penile squamous cell carcinoma. Virchows Arch. 2008;452:369-75.

Schlenker B, Scher B, Tiling R, Siegert S, Hungerhuber E, Gratzke C, et al. Detection of inguinal lymph node involvement in penile squamous cell carcinoma by 18F- fleurodeoxyglucose PET/CT: a prospective single center study. Urol Oncol. 2012;30:55-9.

Leijte JA, Kerst JM, Bais E, Antonini N, Horenblas S. Neoadjuvant chemotherapy in advanced penile carcinoma. Eur Urol. 2007;52:488-94.

Mistry T, Jones RW, Dannatt E, Prasad KK, Stockdale AD. A 10 years retrospective audit of penile cancer management in the UK. BJU Int. 2007;100;1277-81.

McDougal WS. Carcinoma of penis: improved survival by early regional lymphadenectomy. J Urol. 1995;154:1364-6.

Leijte JA, Horenblass S. Shortcomings of the current TNM classification for penile carcinoma, time for change? World J Urol. 2009;27:151-4.

Leijte JA, Hughes B, Graafland NM, Kroon BK, Olmos RA, Nieweg OE, et al. Reliability and safety of current dynamic sentinel node biopsy for squamous cell penile carcinoma. J Clin Oncol. 2009;27:3325-9.