Surgical treatment of patients with penile cancer with inguinal lymph node metastasis

   Penile cancer is a relatively rare malignant tumor, the cause of which is still unclear. It mostly occurs in patients with prepuce or circumcision, in addition to smoking, external genital warts and penile rash, which are all related to the incidence of penile cancer. Penile cancer is mostly located in the inner plate of foreskin, coronal sulcus and penile head, with papillary or cauliflower-like protrusion, accompanied by purulent discharge and foul odor, brittle and easy to bleed.  It is usually squamous cell carcinoma, accounting for 95% of the cases. Others include basal cell carcinoma, adenocarcinoma, malignant melanoma, etc. are relatively rare. For patients with penile cancer with lymph node metastasis, statistics show that the 5-year survival rate is 95-100% when there is no inguinal lymph node metastasis, 80% when there is single inguinal lymph node metastasis, 50% when there is multiple inguinal lymph node metastasis, and 0% when there is pelvic and peripheral lymph node metastasis. Swollen lymph nodes in the inguinal region can be palpated in 50% of penile cancer patients at the time of consultation. In 25% of these patients, the swollen lymph nodes are associated with ulceration and inflammation caused by the primary lesion, and the swollen lymph nodes can disappear after 4-6 weeks of antibiotic treatment. If there is no change, further surgical treatment is recommended. Surgical treatment involves unilateral or bilateral inguinal lymph node dissection in addition to partial or total excision of the primary lesion (penis).  Patients undergoing traditional inguinal lymph node dissection usually take an oblique incision on the groin, and the length of the incision is usually 20 cm, which often faces problems such as postoperative lymphatic leakage, long wound healing period, wound infection, and long retention time of drainage tubes. At present, our department carries out inguinal lymph node dissection, mainly laparoscopic minimally invasive surgery, establishing subcutaneous channels in the bilateral inguinal area, filling the space with C02 and discharging superficial and deep inguinal lymph nodes. The postoperative wound healing time and infection rate are significantly lower than those of traditional open surgery.  Laparoscopic inguinal lymph node dissection has now become the mainstream surgery in our department, with clear surgical results.