Urology Department, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil.
Int Braz J Urol. 2012 Mar-Apr;38(2):289; discussion 290. doi: 10.1590/s1677-55382012000200020.
Penile cancer is a rare disease, most commonly encountered in developing countries. It constitutes 0.4% of cancers in U.S. men and 2.1% in Brazil, with the highest prevalence in the North and Northeast regions. Inguinal lymph node metastasis of penile cancer occurs in 20 to 40% of patients and is an important predictor of cancer-specific mortality. The preferred diagnostic and therapeutic tool to assess the regional lymph nodes is a lymphadenectomy which can, in addition to establishing staging, offers curative potential.
A 44 years old man, previously to underwent a partial penectomy for penile cancer, whose pathology showed a moderately differentiated squamous cell carcinoma with neural and angiolymphatic invasion and negative surgical margins. The pathologic stage of the primary tumor was pT3NxMx. Following a one month course of oral antibiotics, the patient underwent a video-assisted bilateral inguinal lymphadenectomy. In the present video, we highlight the left video-assisted inguinal lymphadenectomy.
Seventeen lymph nodes were dissected on the left side, two of them positive for cancer without extracapsular extension. On the right side, fourteen lymph nodes were dissected and one was positive for cancer with extracapsular extension, and the patient underwent based on these pathological findings a pelvic lymphadenectomy, which was similarly conducted using a video-assisted laparoscopic approach.
The conventional open lymphadenectomy has a morbidity that can approach 50% in the current series, despite on the refinements in technique. The video-assisted endoscopy is a recent technique aiming to decrease this inherent complication rate promoting a lymph node resection rate which may be equivalent to the open procedure. This video confirms its feasibility, reduced morbidity, and cancer control efficacy.
阴茎癌是一种罕见疾病，在发展中国家最为常见。它在美国男性中占癌症的 0.4%，在巴西占 2.1%，在北部和东北部地区发病率最高。阴茎癌的腹股沟淋巴结转移发生在 20%至 40%的患者中，是癌症特异性死亡率的重要预测指标。评估区域淋巴结的首选诊断和治疗工具是淋巴结切除术，它除了确定分期外，还具有潜在的治愈能力。
一名 44 岁男性，此前因阴茎癌接受了部分阴茎切除术，其病理显示为中分化鳞状细胞癌，伴有神经和血管淋巴管侵犯，且手术切缘阴性。原发性肿瘤的病理分期为 pT3NxMx。在口服抗生素治疗一个月后，患者接受了双侧腹股沟淋巴结视频辅助切除术。在本视频中，我们重点介绍左侧视频辅助腹股沟淋巴结切除术。
左侧共切除 17 个淋巴结，其中 2 个淋巴结有癌症转移但无包膜外侵犯。右侧共切除 14 个淋巴结，其中 1 个淋巴结有癌症转移且有包膜外侵犯。根据这些病理发现，患者接受了基于盆腔淋巴结切除术，同样采用视频辅助腹腔镜方法进行。
在本系列中，即使在技术上有所改进，传统的开放性淋巴结切除术的发病率仍可接近 50%。视频辅助内镜技术是一种旨在降低这种固有并发症发生率的新技术，可实现与开放性手术相当的淋巴结切除率。本视频证实了其可行性、较低的发病率和癌症控制效果。
