One hundred cases were studied in detail using lymphangiograms (LAG), anatomic dissections, and/or microscopic evaluation. LAG performed via the dorsal lymphatics of the penis demonstrate the existence of specific lymph node center, the so-called sentinel lymph node (SLN). This appears to be the primary site of metastases from penile carcinoma. The SLN is visualized radiographically, on the antero-posterior view, at the junction of the femoral head and the ascending ramus of the pubis. Anatomically, the SLN is part of the lymphatic system around the superficial epigastric vein. Forty-six SLN biopsies were performed with 15 positive for metastatic disease. In these 15 patients, an inguinofemoroiliac dissection was performed; in 12 cases there was no involvement of other lymph nodes. Lymphatic channels draining into the iliac lymph nodes without first draining into the sentinel lymph node were never demonstrated, nor were the inguinal-femoral lymph nodes involved in the absence of SLN involvement. On this bases, we recommend preliminary bilateral SLN biopsy to be followed by inguinofemoroiliac dissection when biopsy of the SLN biopsy to be followed by inguinofemoroiliac dissection when biopsy of the SLN is positive. When biopsy of the SLN is negative for metastatic disease, no further surgical therapy is immediately indicated. With negative SLN, 5-year survival was 90%. When SLN alone was involved, 5-year survival was 70%. Five-year survival was 50% with both SLN and other inguinal nodes involved. When iliac metastases were also present, 3-year survival was 20%.

An approach for the treatment of penile carcinoma

Surgical treatment of invasive squamous cell carcinoma of the penis : retrospective analysis of 350 cases

Modified Inguinal Lymphadenectomy for Carcinoma of the Penis with Preservation of Saphenous Veins: Technique and Preliminary Results

Purpose Men with penile squamous cell carcinoma and regional lymph node involvement have a low probability of survival with lymphadenectomy alone. A multimodal approach to treatment is desirable for such patients. We performed a phase II study of neoadjuvant chemotherapy with the objective of determining the response rate, time to progression (TTP), and overall survival (OS) among patients with bulky adenopathy. Patients and Methods Eligible patients had stage N2 or N3 (stage III or stage IV) penile cancer without distant metastases. Neoadjuvant treatment (four courses every 3-4 weeks) consisted of paclitaxel 175 mg/m2 administered over 3 hours on day 1; ifosfamide 1,200 mg/m2 on days 1 to 3; and cisplatin 25 mg/m2 on days 1 to 3. Clinical and pathologic responses were assessed, and patient groups were compared for TTP and OS. Results Thirty men received chemotherapy of whom 15 (50.0%) had an objective response and 22 (73.3%) subsequently underwent surgery. Three patients had no remaining tumor on histopa...

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Neoadjuvant Paclitaxel, Ifosfamide, and Cisplatin Chemotherapy for Metastatic Penile Cancer: A Phase II Study

Summary Although rare in developed countries, carcinoma of the penis is an important problem in the developing world. Circumcision done in childhood offers the greatest protection against this disease. Poor penile hygiene and phimosis are strong risk factors for development of penile carcinoma. Early disease can be treated by conventional resection of the penis, or in selected patients by organ preserving techniques including Mohs micrographic surgery, and laser and radiation therapy For more advanced primary disease, partial or total penectomy is needed. Elective or therapeutic lymphnode dissection is recommended for inguinal metastatic disease, and depending on the disease status, unilateral or bilateral inguinal or ilioinguinal lymphadenectomy might be needed. The role of chemotherapy, as adjuvant or primary treatment in metastatic disease, needs to be defined in prospective clinical trials, which can be done in developing countries.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(04)01427-5.pdf

Penile carcinoma: a challenge for the developing World

The prognosis of squamous carcinoma of the penis depends upon the stage of disease as determined by local invasion and involvement of inguinal nodes. Three-year survivals of 48 cases were: Stage I, 95%; Stage II, 67%; Stage III, 29%; and Stage IV, 0%. Most primary lesions were treated by partial penectomy, and no patient developed local recurrence. There was a significant discrepancy between initial clinical staging and histologic staging due to the difficulty in determining node metastases. In order to detect and eliminate occult metastases an aggressive approach to the inguinal nodes is proposed, including en bloc ileo-inguinal dissection for persistent clinical adenopathy, and routine superficial inguinal node biopsy of non-palpable nodes when the primary invades the corpora. The “skin bridge” technique of node dissection has some important advantages: the groin crease is not incised, and the blood supply to the flaps is preserved.

J. P. Fegen

Papers

Carcinoma of the penis