Presented Thursday, 06 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Unfortunately the presence of bulky inguinal lymph nodes metastases in patients with scuamous cell carcinoma (SCC) of the penis determines a poor prognosis, the salvage of these cases being a challenge for urologists.

Material & Methods: Between 1985 and January 2006 in our center for patients with penile SCC 62 inguinofemoral lymphadenectomies were performed. In 38 cases with positive multiple or bulky inguinal lymphnodes, the operations were completed in a radical ilioinguinal lymph node dissection. In this video, we present the case of a 37 year old patient with glansectomy and circumcision with skin graft on the corporal heads for a pT2G2 glans tumor developed under a neglected phymosis. Bulky palpable mobile adenopathy was found in the right inguinal area with no pelvic lymph nodes enlargement or distant metastases on abdominopelvic CT scan. After 4 weeks of antibiotic therapy, we performed bilateral complete inguinofemoral lymph node dissection. Pathological exam revealed multiple bilateral SCC lymph nodes metastases. Consequently, we performed bilateral pelvic lymph node dissection, pathological exam revealing one obturatory positive lymph node pN3. Postoperative, the patients underwent 12 cycles of Cisplatinium and 5-FU chemotherapy during 1 year.

Results: The cancer specific survival in the group with multiple or bulky inguinal lymph nodes (38 pts) after a median 48 month follow-up period (9-240 months) was 58% in patients with negative pelvic nodes (14 from 24 pts) and 14% in patients with positive pelvic nodes (2 from 14 pts.). The introduction of plastic penile surgery - skin graft on the corporal heads after glansectomy or partial penile amputation, helps salvage the cosmetic appearance and sexual function. In the case presented in our video, three years postoperatively, the patient is free of cancer on their physical exam, abdominopelvic CT scan and chest x-ray, with a good cosmetic outcome and satisfactory sexual activity.

Conclusion: Plastic penile surgery, radical ilioinguinal lymphadenectomy and chemotherapy represent an effective oncological and functional multimodal salvage therapy for patients with penile SCC and bulky inguinal lymph nodes metastases.

Authors: Gingu C, Patrascoiu S, Harza M, Chibelean C, Stefan B, Balsanu C, Tica D, Surcel C, Sinescu I

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