Penile cancer is the most common tumor of the penis, accounting for 90-97% of penile tumors, and often causes great mental and physical pain to patients. Most patients with penile cancer are combined with penile tumor, and squamous cell carcinoma (95%) is the common pathological type.
I. Treatment of primary foci
1.Treatment of penis preservation (Tis, T1,N0).
2.Partial penile removal (poorly differentiated T1,T2).
3.Total penile excision (T2 stage or above).
II. Treatment of lymph nodes
1.About half of the patients with penile cancer can have palpable inguinal enlarged lymph nodes, 25% of which are related to ulceration and inflammation of the primary focus; domestic guidelines suggest applying antibiotics for anti-inflammation first, and then inguinal lymph node dissection is needed if it is ineffective; European urology guidelines suggest ultrasound-guided aspiration biopsy;
2. For those who are not palpated at the time of diagnosis, 20%-25% of patients have micrometastases.
III. Lymph node metastasis and prognosis
1. The 5-year survival rate of patients (without lymph node metastasis) is 95%-100%.
2.The 5-year survival rate of patients is 80%.
3.The 5-year survival rate of patients is 50%.
4.The 5-year survival rate of patients was 0%.
IV. (No lymph node metastasis) and prognosis
1.The 5-year survival rate of those with lymph node metastasis confirmed by prophylactic lymph node dissection was 80%-90%.
2. 30%-40% of the patients with lymph node metastasis were observed to be cleared again.
V. Treatment of positive lymph nodes
1, clinical diagnosis of positive lymph node cases: inguinal lymph node dissection is required, such as positive ice, European urological guidelines recommend ipsilateral radical inguinal lymph node dissection, while the domestic recommendation is bilateral inguinal dissection.
2.Pelvic lymph node dissection is required for inguinal lymph node metastasis greater than 2.
3.N3 surgery to reduce symptoms and radiotherapy.
At present, for penile cancer patients with inguinal lymph node metastasis and those with negative clinical inguinal lymph node examination but with high-risk factors, inguinal lymph node dissection is the best treatment. However, the complications of open surgery such as lymphatic leakage, lymphedema, hematoma, flap necrosis, and incisional infection are up to 50%.
Inguinal lymph node dissection includes radical inguinal lymph node dissection (or iliac inguinal lymph node dissection) and prophylactic inguinal lymph node dissection, both of which differ in the extent of dissection.
Prophylactic inguinal lymph node dissection uses a modified inguinal lymph node dissection: superior border: spermatic cord; inferior border: oval fossa: external border: femoral artery: internal border: internal longissimus dorsi.
And laparoscopic prophylactic inguinal lymph node dissection has fewer complications and smaller incisions than open surgery, which is a safe and effective method to prevent and treat inguinal lymph node metastasis of penile cancer and can obviously improve the survival time of penile cancer patients. However, this surgery requires skillful laparoscopic operation technique and skilled inguinal local dissection. We have carried out laparoscopic prophylactic inguinal lymph node dissection for penile cancer in 2013, which has less trauma, complications, fast recovery and significantly prolonged survival, and patients are happy to accept it.