A map of pelvic lymph node metastasis (LNM) in penile cancer patients helps to clarify the pattern of pelvic spread and define the reasonable limits of dissection. It hasn't been established. We aim to provide an accurate map of LNM in penile cancer patients and determine the reasonable extent of pelvic lymph node dissection (PLND).
We enrolled penile cancer patients undergoing PLND (n=128) at our institution from 1999 to 2018. The numbers of removed LNs and positive LNs at 10 distinct regions were recorded. The chi-square and Fisher exact tests were used.
The median number of pelvic LNs retrieved was 18 (IQR: 10-30), with the majority being from the external iliac package (43.0%) and obturator package (31.9%). PLNM was present in 57/128 (44.5%) patients. The median number of positive pelvic LNs removed was two (IQR: 1-4), with the majority being from the external iliac package (50.0%) and obturator package (36.6%). Advanced T-stage was related with higher risk of PLNM, which was present in 30.3%, 44.2%, 59.0%, and 58.3% of patients with pT1, pT2, pT3, and pT4. Notably, two patients had crossover metastasis from one inguinal region to contralateral pelvic region.
We present a detailed map of PLNM in penile carcinoma patients. The external iliac and obturator packages appear to be most commonly involved. Optimal PLND may extend to the common iliac artery, including common iliac, external iliac, internal iliac and obturator LNs. ENE in inguinal nodes may not be as important as previously thought.
The Journal of urology. 2020 Aug 05 [Epub ahead of print]
Kai Yao, Yue Chen, Yunlin Ye, Zhiming Wu, Dong Chen, Hui Han, Zaishang Li, Zhuowei Liu, Yanjun Wang, Zike Qin, Yonghong Li, Zhiyong Li, Fangjian Zhou
State Key Laboratory of Oncology in Southern China, Guangzhou, China.