Wawroschek F, Winter A
Universitätsklinik für Urologie, Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland.
Urologe A. 2018 Apr;57(4):435-439. doi: 10.1007/s00120-018-0598-2.
In penile cancer, lymph node metastasis is the main known prognostic factor affecting patients' survival. Early inguinal lymph node dissection or the resection of clinically occult lymph node metastases improves survival compared with removal when the metastases become clinically apparent. Micrometastatic lymph node involvement is undetectable by current imaging modalities. Nomograms based on clinical and histopathological tumor characteristics are unreliable in predicting lymph node involvement. Consequently, in penile cancer patients with clinically normal inguinal lymph nodes (cN0) and a tumor stage ≥pT1, G2 surgical lymph node exploration is recommended. Radical inguinal lymphadenectomy is no longer recommended because of its invasiveness and high complication rate. Modified lymphadenectomy and dynamic sentinel lymph node surgery allow the detection of lymph node-positive patients with sufficient certainty. Thereby, the sentinel lymph node approach offers the least invasiveness and high sensitivity. Extended inguinal lymphadenectomy is still recommended in the case of positive nodes.
在阴茎癌中，淋巴结转移是影响患者生存的主要已知预后因素。与转移灶出现临床症状后再进行切除相比，早期腹股沟淋巴结清扫术或切除临床隐匿性淋巴结转移灶可提高生存率。目前的成像方式无法检测到微转移淋巴结受累情况。基于临床和组织病理学肿瘤特征的列线图在预测淋巴结受累方面并不可靠。因此，对于临床腹股沟淋巴结正常（cN0）且肿瘤分期≥pT1、G2的阴茎癌患者，建议进行手术性淋巴结探查。由于根治性腹股沟淋巴结清扫术具有侵袭性且并发症发生率高，因此不再推荐。改良淋巴结清扫术和动态前哨淋巴结手术能够足够准确地检测出淋巴结阳性患者。因此，前哨淋巴结方法具有最小的侵袭性和高敏感性。对于淋巴结阳性的情况，仍建议进行扩大腹股沟淋巴结清扫术。
