Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis.

Abstract

Classic inguinal lymphadenectomy for penile cancer is associated with significant immediate and long-term sequelae limiting its use in the prophylactic setting. Preservation of the saphenous vein has been shown in the gynecological oncology literature to reduce the morbidity of inguinal lymphadenectomy. In addition, saphenous vein sparing coupled with thick skin flaps and limited lymphadenectomy for penile cancer has been associated with minimal morbidity. Reports on saphenous vein preservation in men undergoing inguinal lymphadenectomy are limited and, therefore, we reviewed our experience. We reviewed retrospectively 11 patients with stage pT1-T3 cN0 M0 grades I to III carcinoma of the penis or penile urethra who underwent bilateral inguinal lymphadenectomy with saphenous vein sparing and thick skin flaps between August 1995 and November 2001. Of the patients 1 underwent simultaneous penectomy and 10 had undergone a partial or total penectomy previously. Short-term and long-term postoperative complications were defined as minor-did not require significant medical intervention and included superficial skin edge sloughing, seroma and lymphocele, and major-skin edge or flap necrosis, wound infection, deep venous thrombosis or leg edema inhibiting return to pretreatment activities. Mean followup was 9 months. The saphenous vein was preserved in 19 groins and ligated in 3. Simultaneous bilateral pelvic lymphadenectomy was performed in 5 patients. Nodal disease was found in 5 of 11 (45%) patients on pathological review. Minor short-term complications occurred in 8 of 22 (36%) groins, and major complications included deep venous thrombosis in 1 case and a small myocardial infarction in 1. There was no perioperative mortality. Lower extremity lymphedema requiring more than temporary (less than 6 months) support hose management did not occur in any patient. There were no inguinal recurrences during followup. Inguinal lymphadenectomy with saphenous vein sparing and thick skin flaps appears to offer excellent functional outcome in patients undergoing prophylactic bilateral inguinal lymphadenectomy for high risk disease. Early followup indicates that the local recurrence rate does not appear to increase compared to similar patients reported on in the literature treated with the classic dissection technique.