Niyogi Devayani, Noronha Jarin, Pal Mahendra, Bakshi Ganesh, Prakash Gagan
Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Urol. 2020 Jan-Mar;36(1):8-15. doi: 10.4103/iju.IJU_221_19.
Malignant penile neoplasms are commonly squamous etiology, with the inguinal nodes being the first echelon of spread. The disease spreads to the pelvic lymph nodes only after metastases to the groin nodes, and this is the most important prognostic factor in penile carcinoma. While treatment of penile carcinoma with proven metastases to the inguinal lymph nodes mandates ilioinguinal lymph node dissection, the treatment of patients with impalpable nodes is more controversial. Overtreatment leads to excessive treatment-related morbidity in these patients, while a wait-and-see policy runs the risk of patients presenting with inguinal and distant metastases, which would have been curable at presentation. Unfortunately, no single imaging modality has been proved to be convincingly superior in the staging, and hence, management of the clinically negative groin has been subject to debate. While some high volume centers have promoted the use of dynamic sentinel lymph node biopsy, others advocate the use of the modified inguinal lymph node template to stage the groin adequately. Newer techniques such as video endoscopic inguinal lymph node dissection have been introduced as an alternative to the original radical inguinal lymphadenectomy to reduce morbidity.
恶性阴茎肿瘤通常起源于鳞状上皮，腹股沟淋巴结是首要的转移部位。该疾病只有在腹股沟淋巴结转移后才会扩散至盆腔淋巴结，这是阴茎癌最重要的预后因素。对于已证实腹股沟淋巴结转移的阴茎癌患者，治疗需行髂腹股沟淋巴结清扫术，而对于触诊未及肿大淋巴结患者的治疗则更具争议性。过度治疗会导致这些患者出现过多与治疗相关的并发症，而观望策略则有使患者出现腹股沟及远处转移的风险，而这些转移在初诊时本是可治愈的。不幸的是，尚无单一影像学检查方法被证实能在分期方面具有令人信服的优势，因此，临床上腹股沟阴性的处理一直存在争议。虽然一些大型中心提倡使用动态前哨淋巴结活检，但另一些则主张使用改良腹股沟淋巴结模板来充分评估腹股沟情况。诸如视频内镜腹股沟淋巴结清扫术等新技术已被引入，作为原始根治性腹股沟淋巴结切除术的替代方法以降低并发症发生率。
