NEW YORK (Reuters Health) – Morbidity associated with inguinal lymphadenectomy in patients with penile carcinoma has declined, and is “reasonable” considering the potential benefit, a Brazilian team reports.

Furthermore, they advise, an open procedure should remain the gold standard “until studies with larger samples and longer follow-up may show that minimally invasive approaches are really advantageous.”

They note in the Journal of Urology online June 12 that lymphadenectomy is potentially curative in squamous cell carcinoma of the penis, but many patients do not undergo the procedure in part because of the historically high rate of serious complications.

Nonetheless, Dr. Antonio Augusto Ornellas at the Instituto Nacional de Cancer in Rio de Janeiro and colleagues recommend radical inguinal lymphadenectomy for patients with clinically negative lymph nodes and a high risk of dissemination (prophylactic excision), as well as for those with clinically positive nodes (therapeutic excision).

For the current study, they evaluated complication rates related to lymphadenectomy in 170 patients who had undergone varying degrees of penile resection depending on tumor extent. Open, radical bilateral lymphadenectomy (representing 340 unilateral operations) was performed either simultaneously or up to 6 weeks after the primary tumor treatment.

There were a total of 35 complications (10.3%), 25 of which were minor and 10 were major, the team reports. Complications included lymphedema in 14 patients, seroma in 4, scrotal edema in 3, skin edge necrosis in 3, lymphocele in 3, wound infection ion 2, flap necrosis in 2, wound abscess in 2 and deep venous thrombosis in 2.

Dr. Ornellas and colleagues attribute the relatively low complication rate to various factors, including surgical technique and lymphedema prevention measures, “meticulous control of lymphatics and blood vessels along the margins of subcutaneous tissue,” and optimal postoperative care.

In fact, they conclude, “To our knowledge, this series presents the lowest incidence rate of complications described in the international literature.”

SOURCE: Radical Open Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Technique, Early Complications, and Late Outcomes – Evaluation of 340 Procedures
J Urol 2013.