Nerli R B, Sharma Manas, Patel Priyeshkumar, Ghagane Shridhar C, Patil Shashank D, Gupta Pulkit, Hiremath Murigendra B, Dixit Neeraj S
Department of Urology, JN Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi, Karnataka 590010 India.
Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010 India.
Indian J Surg Oncol. 2021 Mar;12(1):229-234. doi: 10.1007/s13193-021-01285-w. Epub 2021 Feb 5.
Cancer of the penis is an important health problem in India, causing significant morbidity. Involvement of locoregional lymph nodes is the most significant prognostic factor for patients with penile cancer. In this study, we reviewed clinical data of all patients who underwent modified inguinal lymph node dissection as a means to diagnose micro-metastasis in inguinal lymph nodes, and analysed the outcomes. We retrospectively reviewed the hospital clinical charts of patients treated for carcinoma of the penis. Inguinal and distant metastases were assessed by physical examination, ultrasound imaging of the inguinal region, computed tomography of the abdomen and pelvis and a chest radiograph. Patients with clinically negative inguinal lymph nodes underwent modified lymph node dissection (mILND) both to diagnose and stage the disease. Complications occurring during a 30-day period after surgery were defined as early and thereafter as late complications. A total of 40 patients with a mean age of 52.27±13.10 (range 25-73) years underwent mILND. Wedge biopsy from the primary lesion had revealed intermediate-risk disease in 22 (55%) patients and high-risk disease in 18 (45%) patients. Histopathological examination of the primary penile lesion revealed a pT1 lesion in 32 patients and a pT2 lesion in the remaining 8 patients. Fourteen (35%) of the 40 patients showed micro-metastases in the inguinal lymph nodes on frozen sections. The mean follow-up in these patients was 56.6±18.09 months. There were no instances of local or systemic recurrences seen in 38 (95%) patients within 5 years. Superficial lymph node dissection and where facilities are available DSLNB remain the standard of care in the management of patients with clinically groin-negative (cN0) intermediate- and high-risk groups. Modified inguinal lymph node dissection would be a safe and appropriate alternative to this in all centres that do not have access to newer modalities like DSLNB, video-endoscopic (VEIL) or robotic-assisted techniques.
阴茎癌在印度是一个重要的健康问题，会导致严重的发病情况。局部区域淋巴结受累是阴茎癌患者最重要的预后因素。在本研究中，我们回顾了所有接受改良腹股沟淋巴结清扫术以诊断腹股沟淋巴结微转移的患者的临床数据，并分析了结果。我们回顾性地查阅了接受阴茎癌治疗的患者的医院临床病历。通过体格检查、腹股沟区超声成像、腹部和盆腔计算机断层扫描以及胸部X线片评估腹股沟和远处转移情况。临床腹股沟淋巴结阴性的患者接受改良淋巴结清扫术（mILND）以诊断疾病并进行分期。术后30天内发生的并发症定义为早期并发症，之后发生的定义为晚期并发症。共有40例患者接受了mILND，平均年龄为52.27±13.10（范围25 - 73）岁。原发灶楔形活检显示22例（55%）患者为中危疾病，18例（45%）患者为高危疾病。阴茎原发灶的组织病理学检查显示32例患者为pT1病变，其余8例患者为pT2病变。40例患者中有14例（35%）在冰冻切片时显示腹股沟淋巴结有微转移灶。这些患者的平均随访时间为56.6±18.09个月。38例（95%）患者在5年内未出现局部或全身复发情况。对于临床腹股沟阴性（cN0）的中高危组患者，浅表淋巴结清扫术以及在有条件的情况下进行DSLNB仍然是治疗的标准方法。在所有无法获得如DSLNB、视频内镜（VEIL）或机器人辅助技术等更新方法的中心，改良腹股沟淋巴结清扫术将是一种安全且合适的替代方法。
