Tsaur Igor, Biegel Carmen, Gust Kilian, Huesch Tanja, Borgmann Hendrik, Brandt Maximilian P J K, Kurosch Martin, Reiter Michael, Bartsch Georg, Schilling David, Haferkamp Axel
Department of Urology and Pediatric Urology, Goethe-University, Frankfurt am Main, Germany.
Int Braz J Urol. 2015 May-Jun;41(3):486-95. doi: 10.1590/S1677-5538.IBJU.2014.0304.
In patients with penile cancer (PeCa) and increased risk of inguinal lymphatic dissemination, inguinal lymphadenectomy offers a direct histological staging as the most reliable tool for assessment of the nodal metastasic status and a definitive oncologic treatment simultaneously. However, peri- and/or postoperative mutilating sequalae often occurn. We report on clinical outcome and complications of a limited inguinal lymph node (LN) dissection.
Clinical and histopathological data of all patients with PeCa who underwent limited inguinal lymphadenectomy (LIL) at our institution between 1986 and 2012 were comprehensively analyzed. Perioperative results were presented in relation to one-sided procedures, if appropriate, which were assessed without cross comparison with contralateral LILs.
29 consecutive patients with PeCa aged 60±10.3 years were included in the current study with 57 one-sided LIL performed. Mean operative time for one-sided LIL was 89.0±37.3 minutes with 8.1±3.7 LNs removed. A complication rate of 54.4% (n=31), including 16 minor and 15 major complications was found in a total of 57 procedures with leg oedema being the most prevalent morbidity (15.8%). 4 patients with clinically positive LNs developed inguinal lymphatic recurrence within 9 months after surgery.
Our technique of limited inguinal LN dissection provided an acceptable complication rate without aggravating morbidity. We experienced no recurrences in clinically LN negative patients, so that the approach might be a reasonable option in this scenario. In patients with enlarged LNs, radical inguinal lymphadenectomy still appears to represent the gold standard.
在阴茎癌（PeCa）患者且腹股沟淋巴转移风险增加的情况下，腹股沟淋巴结清扫术可提供直接的组织学分期，作为评估淋巴结转移状态最可靠的工具，同时也是一种确定性的肿瘤治疗方法。然而，围手术期和/或术后致残性后遗症经常发生。我们报告了有限腹股沟淋巴结清扫术的临床结果和并发症。
对1986年至2012年期间在我院接受有限腹股沟淋巴结清扫术（LIL）的所有PeCa患者的临床和组织病理学数据进行了全面分析。围手术期结果针对单侧手术进行了阐述（如适用），且未与对侧LIL进行交叉比较评估。
本研究纳入了29例连续的PeCa患者，年龄为60±10.3岁，共进行了57例单侧LIL。单侧LIL的平均手术时间为89.0±37.3分钟，切除淋巴结8.1±3.7枚。在总共57例手术中，并发症发生率为54.4%（n = 31），包括16例轻微并发症和15例严重并发症，腿部水肿是最常见的并发症（15.8%）。4例临床淋巴结阳性患者在术后9个月内出现腹股沟淋巴复发。
我们的有限腹股沟淋巴结清扫术技术提供了可接受的并发症发生率，且未增加发病率。我们在临床淋巴结阴性的患者中未观察到复发情况，因此在这种情况下该方法可能是一个合理的选择。对于淋巴结肿大的患者，根治性腹股沟淋巴结清扫术似乎仍然是金标准。
