Suarez-Ibarrola Rodrigo, Basulto-Martinez Mario, Sigle August, Abufaraj Mohammad, Gratzke Christian, Miernik Arkadiusz
Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, 79106 Freiburg, Germany.
Department of Urology, Hospital Regional de Alta Especialidad de la Peninsula de Yucatán, Merida 97133, Mexico.
J Clin Med. 2021 Feb 13;10(4):754. doi: 10.3390/jcm10040754.
We aim to review the literature for studies investigating the oncological outcomes of patients with penile cancer (PC) undergoing bilateral pelvic lymph node dissection (PLND) in the presence of inguinal lymph node metastasis (LNM) who are at risk of harboring pelvic metastasis. A search of English language literature was performed using the PubMed-MEDLINE database up to 3 December 2020 to identify articles addressing bilateral PLND in PC patients. Eight articles investigating bilateral PLND met our inclusion criteria. Patients with pelvic LNM have a dismal prognosis and, therefore, PLND has an important role in both the staging and treatment of PC patients. Ipsilateral PLND is recommended in the presence of ≥2 positive inguinal nodes and/or extranodal extension (ENE). Significant survival improvements were observed with a higher pelvic lymph node yield, in patients with pN2 disease, and in men treated with bilateral PLND as opposed to ipsilateral PLND. Nevertheless, the role of bilateral PLND for unilateral inguinal LNM remains unclear. Although the EAU guidelines state that pelvic nodal disease does not occur without ipsilateral inguinal LNM, metastatic spread from one inguinal side to the contralateral pelvic side has been reported in a number of studies. Further studies are needed to clarify the disseminative pattern of LNM, in order to establish PLND templates according to patients' risk profiles and to investigate the benefit of performing bilateral PLND for unilateral inguinal disease.
我们旨在回顾文献，以研究阴茎癌（PC）患者在存在腹股沟淋巴结转移（LNM）且有盆腔转移风险的情况下接受双侧盆腔淋巴结清扫术（PLND）的肿瘤学结局。利用PubMed-MEDLINE数据库对截至2020年12月3日的英文文献进行检索，以识别涉及PC患者双侧PLND的文章。八项研究双侧PLND的文章符合我们的纳入标准。盆腔LNM患者预后不佳，因此PLND在PC患者的分期和治疗中均具有重要作用。当腹股沟淋巴结≥2枚阳性和/或出现结外侵犯（ENE）时，建议行同侧PLND。在盆腔淋巴结切除数量较多的患者、pN2期疾病患者以及接受双侧PLND而非同侧PLND治疗的男性中，观察到生存有显著改善。然而，双侧PLND对单侧腹股沟LNM的作用仍不明确。尽管欧洲泌尿外科学会（EAU）指南指出，若无同侧腹股沟LNM则不会出现盆腔淋巴结疾病，但多项研究报告了转移灶从一侧腹股沟扩散至对侧盆腔的情况。需要进一步研究以阐明LNM的播散模式，从而根据患者的风险特征建立PLND模板，并研究对单侧腹股沟疾病行双侧PLND的益处。
