Author(s): Inuganti Gopal, Sumita Tripathy
Diagnosing penile cancer and grading the same with available diagnostic tools is not difficult, but the problem lies in the management and more so in groin node dissection. Lymphadenectomy is the treatment of choice in patients presenting with positive node at the time of diagnosis, but problem arises in deciding node negative patients. Our aim was to evaluate role of prophylactic inguinal lymphadenectomy in carcinoma of penis.
This was a prospective study carried out at MKCG Medical College and Hospital from 2012 to 2017. The clinical, diagnostic and follow-up data were collected from patient records.
A total 30 cases of penile carcinoma were included in the present study. Youngest patient was 29 years of age and oldest was of 78 years. 18 patients showed inguinal lymphadenopathy at the time of diagnosis. FNAC showed node positivity in 10 cases. 2 out of 8 cytologically negative lymph nodes for metastatic deposits came out to be positive after biopsy. Histologically majority diagnosed as moderately differentiated squamous cell carcinoma and were in stage 2. 2 patients diagnosed as verrucous
carcinoma. Radical inguinal lymphadenectomy was done in all patients with cytologically proven metastatic deposits, modified radical dissection done in cytologically negative lymphadenopathy cases. In remaining patients of carcinoma penis, without inguinal node involvement, an individualistic approach was undertaken.
In node positive cases, inguinal node dissection should be carried out, but in node negative cases decision should be more individualistic. It is better to go for a modified radical dissection even with negative node, as it is commonly seen in our set up that patients are lost to follow up. But it should be carried out in a judicious way with an individualistic approach as groin dissection is a mutilating surgery with many complications and decision making is a complex issue though we have many available clinical and pathological criteria.