Linfadenectomía extendida pélvica bilateral en cáncer de pene. Aspectos técnicos

Abstract

The most important prognostic factor in cancer of the penis is the presence of lymph node metastases and they are detected in 28 % to 64 % of the cases. Lymphadenectomy is curative in 75 % of the patients presenting with one or 2 positive lymph nodes and in 20 % of the patients with pelvic invasion. Thus it is the most effective treatment for eradicating lymph node metastases in selected patients.A 49-year-old man presented with an indurated, exophytic, 3.5cm vegetative tumor in the glans penis and a right inguinal increase in volume. A biopsy was taken that reported invasive squamous cell carcinoma. Partial phallectomy and bilateral extended superficial inguinal lymphadenectomy were performed. The histopathologic study reported moderately differentiated squamous cell carcinoma measuring 3.7cm that affected the corpus spongiosum, and disease-free margins. There was positive lymph node invasion; 8 right inguinal lymph nodes were found, one of which was positive and 5 left inguinal lymph nodes were identified, one of which was positive.Laparoscopic bilateral extended lymphadenectomy was performed, with 2 positive right obturator lymph nodes.Cancer of the penis is a disease with an unfavorable outcome. Surgery is essential for attempting to cure the patient with lymph node invasion and it improves outcome, reaching a 5-year survival rate above 60 %; in the cases of pelvic lymph node invasion that rate is 20 %. The laparoscopic approach has advantages in relation to morbidity and pain control, as well as an adequate oncologic result.