Penectomy with Simultaneous Compared to deferred Bilateral Inguinal Lymph Node Dissection for Squamous Cell Carcinoma of the Penis - Evaluation of Surgical Complications

RESUMO

Objective: In men with advanced squamous cell carcinoma of the penis; inguinal lymph node dissection is usually deferred for 6 weeks after primary penectomy. The rationale is that the penile lesion is usually infected and immediate lymphadenectomy may lead to a higher surgical complication rate. However; some patients do not return for deferred node dissection and then present much later with incurable metastatic disease. The aim of this study was to compare the complication rates of simultaneous versus deferred bilateral inguinal lymph node dissection. Patients and Methodsn From October 1999 to September 2006; 29 men with histologically confirmed squamous cell carcinoma of the penis were treated. Penectomy with simultaneous bilateral inguinal lymph node dissection was performed in 18 patients with locally advanced primary lesions (cT2 in 8; cT3 in 10) and palpable inguinal nodes. The complications were compared with a previous study of 34 men who underwent bilateral inguinal lymph node dissection at a mean of 72 days after penectomy at Tygerberg Hospital during the period November 1983 to April 1995. Results: Post-operative complications occurred in 11 of 18 patients (61.1) lymphocele formation in 8; lymph leak in 1; wound dehiscence and skin edge necrosis in 5; wound sepsis in 1; lymphedema of the legs in 2; scrotal edema in 1 and cellulitis in 2 patients (more than one complication occurred in some patients). In the previously reported comparison group who had undergone deferred inguinal lymph node dissection at a mean of 72 days after penectomy; complications occurred in 26 of 34 (76.5) patients wound sepsis in 12; wound dehiscence in 7; lymphocele in 7; lymph leak in 4; wound abscess in 3; necrosis of wound edges in 2 and hematoma formation in 1. Conclusion: Penectomy with simultaneous bilateral inguinal lymph node dissection in men with squamous cell carcinoma of the penis does not lead to a higher complication rate compared with primary penectomy and deferred inguinal lymph node dissection performed at a mean of 10 weeks after the primary procedure