Milathianakis Constantine, Bogdanos John, Karamanolakis Dimitrios
Urology Department, Metaxa Cancer Hospital, Piraeus, Greece.
Int J Urol. 2005 Aug;12(8):776-8. doi: 10.1111/j.1442-2042.2005.01137.x.
Inguinal lymphadenectomy has an essential role in the cure of patients with inguinal metastasis from penile cancer; however, this procedure is associated with a significant morbidity. In recent years, modified lymphadenectomy with saphenous vein preservation has been postulated to reduce morbidity. Herein, we present our recent experience with prophylactic inguinal lymhadenectomy and saphenous vein preservation in patients with invasive penile carcinoma and non-palpable inguinal lymph nodes.
Seven patients with invasive squamous cell penile carcinoma, who underwent bilateral prophylactic inguinal lymphadenectomy with saphenous vein preservation between 1995 and 2001, were reviewed retrospectively. Mean age was 67.7 years. The pathological stage of the primary tumor was pT2 in four and pT3 in three patients respectively. Postoperative complications were defined as minor--wound infection, seroma formation requiring drainage, and skin necrosis, and major-- deep venous thrombosis, persistent seroma formation, flap necrosis requiring a skin graft, as well as permanent and disabling leg lymphedema.
Minimum follow up was 2 years. Minor complications--wound infection--occurred in one patient (one groin). No major complications occurred. All patients are alive without evidence of disease recurrence.
Prophylactic inguinal lymphadenectomy seems to offer reduced morbidity in high risk penile cancer patients without compromising survival outcome.
腹股沟淋巴结清扫术在阴茎癌腹股沟转移患者的治疗中起着至关重要的作用;然而,该手术会带来较高的发病率。近年来,有人提出保留大隐静脉的改良淋巴结清扫术可降低发病率。在此,我们介绍我们在侵袭性阴茎癌且腹股沟淋巴结不可触及的患者中进行预防性腹股沟淋巴结清扫术及保留大隐静脉的近期经验。
回顾性分析了1995年至2001年间7例行双侧预防性腹股沟淋巴结清扫术并保留大隐静脉的侵袭性阴茎鳞状细胞癌患者。平均年龄为67.7岁。原发肿瘤的病理分期分别为4例pT2期和3例pT3期。术后并发症分为轻微并发症——伤口感染、需要引流的血清肿形成以及皮肤坏死,以及严重并发症——深静脉血栓形成、持续性血清肿形成、需要植皮的皮瓣坏死,以及永久性和致残性腿部淋巴水肿。
最短随访时间为2年。1例患者(一个腹股沟区)出现轻微并发症——伤口感染。未发生严重并发症。所有患者均存活,无疾病复发迹象。
预防性腹股沟淋巴结清扫术似乎能在不影响生存结果的情况下降低高危阴茎癌患者的发病率。