Ravi R, Shrivastava B R, Mallikarjuna V S
Department of Genitourinary Surgery, Cancer Institute (WIA), Madras, India.
Arch Esp Urol. 1991 Nov;44(9):1123-6.
In node negative patients of invasive penile carcinoma, prophylactic lymphadenectomy is associated with considerable morbidity, while a "wait and watch" policy is associated with up to 20% cancer related mortality in many series. In between, selective node biopsies, including sentinel node biopsies, have been suggested to stage these patients. However, these procedures are unreliable and associated with high false negative rates. The inguinal pick procedure was devised by us to stage these patients more accurately. It is more elaborate that the previously described selective biopsies and includes biopsy of all identifiable nodes in the inguinal region, including the sentinel node area. In our experience of the procedure in 52 patients with invasive penile carcinoma, it was positive in 5 patients (9.6%). However, 7 of the 47 patients with negative result developed inguinal recurrences and 3 other patients developed distant metastases on follow up. The 5-year disease free survival of inguinal pick positive and negative patients was 100% and 82.9%, respectively. The sensitivity of the procedure in detecting regional spread in these patients was only 72%. Thus, the inguinal pick, though associated with no morbidity, can be meaningful only if it is positive and a negative result does not guarantee absence of regional metastases in node negative patients of invasive penile carcinoma.
在浸润性阴茎癌淋巴结阴性患者中，预防性淋巴结清扫术会带来相当高的发病率，而在许多系列研究中，“观察等待”策略与高达20%的癌症相关死亡率有关。介于两者之间的是，有人建议采用选择性淋巴结活检，包括前哨淋巴结活检，来对这些患者进行分期。然而，这些操作不可靠且假阴性率很高。我们设计了腹股沟摘取手术来更准确地对这些患者进行分期。它比之前描述的选择性活检更为精细，包括对腹股沟区域所有可识别的淋巴结进行活检，包括前哨淋巴结区域。根据我们对52例浸润性阴茎癌患者进行该手术的经验，有5例（9.6%）结果为阳性。然而，在47例结果为阴性的患者中，有7例在随访中出现腹股沟复发，另外3例出现远处转移。腹股沟摘取阳性和阴性患者的5年无病生存率分别为100%和82.9%。该手术在检测这些患者区域扩散方面的敏感性仅为72%。因此，腹股沟摘取手术虽然没有发病率，但只有在结果为阳性时才有意义，而阴性结果并不能保证浸润性阴茎癌淋巴结阴性患者没有区域转移。
