World Journal of Urology

, 27:205 | Cite as

Contemporary inguinal lymph node dissection: minimizing complications

  • Philippe E. Spiess
  • Mike S. Hernandez
  • Curtis A. PettawayEmail author
Topic Paper



This review describes the morbidity of inguinal lymph node dissection (ILND) performed as part of the management of penile cancer as well as recent modifications that may reduce the incidence of complications.


A review of the literature was conducted using Pubmed© for studies reporting complication outcomes of ILND for penile cancer. Furthermore, our contemporary results and patient related morbidity associated with ILND performed for penile cancer are reported and compared with prior series.


A review of the literature over the past 25 years identified 27 manuscripts discussing complications of ILND in the context of penile cancer. ILND has traditionally been associated with an 80–100% risk of surgical morbidity, with skin necrosis, wound dehiscence, infection, and lymphedema the predominant findings. Recent technical modifications and management strategies have reduced the associated risks of this surgical procedure. Most recently, we report a 19 and 27% rate of minor and major complications, respectively, for a diagnostic ILND (i.e., superficial ILND alone in the absence of nodal metastasis) and a 29 and 24% rate of minor and major complications, respectively, for a therapeutic ILND (superficial/deep ILND and pelvic lymph node dissection in the presence of nodal metastasis). In contrast, among clinically node negative patients undergoing dynamic sentinel lymph node biopsy as a staging procedure, the reported complication rate was 7%.


The incorporation of novel management strategies and surgical modifications have resulted in decreasing peri-operative morbidity associated with inguinal staging and therapy.


Penile cancer Inguinal lymph node dissection Morbidity 


Conflict of interest statement

There is no conflict of interest.


  1. 1.
    Taussky D, Crook J, Al Ghamdi A, Fleshner N, Jewett MA (2006) Treatment of the inguinal regions in penile cancer: a review of the literature and treatment proposal. Can J Urol 13:2978–2983PubMedGoogle Scholar
  2. 2.
    Kroon BK, Horenblas S, Lont AP, Tanis PJ, Gallee MP, Nieweg OE (2005) Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases. J Urol 173:816–819PubMedCrossRefGoogle Scholar
  3. 3.
    Ravi R (1993) Morbidity following groin dissection for penile carcinoma. Br J Urol 72:941–945PubMedCrossRefGoogle Scholar
  4. 4.
    Ornellas AA, Seixas AL, de Moraes JR (1991) Analysis of 200 lymphadenectomies in patients with penile carcinoma. J Urol 146:330–332PubMedGoogle Scholar
  5. 5.
    Johnson DE, Lo RK (1984) Complications of groin dissection in penile cancer. Experience with 101 lymphadenectomies. Urology 24:312–314PubMedCrossRefGoogle Scholar
  6. 6.
    Coblentz TR, Theodorescu D (2002) Morbidity of modified prophylactic inguinal lymphadenectomy for squamous cell carcinoma of the penis. J Urol 168:1386–1389PubMedCrossRefGoogle Scholar
  7. 7.
    Milathianakis C, Bogdanos J, Karamanolakis D (2005) Morbidity of prophylactic inguinal lymphadenectomy with saphenous vein preservation for squamous cell penile carcinoma. Int J Urol 12:776–778PubMedCrossRefGoogle Scholar
  8. 8.
    Slaton JW, Morgenstern N, Levy DA, Santos MW Jr, Tamboli P, Ro JY, Ayala AG, Pettaway CA (2001) Tumor stage, vascular invasion, and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol 165:1138–1142PubMedCrossRefGoogle Scholar
  9. 9.
    Wein A, Kavoussi L, Novick AC, Partin AW, Peters CG (2007) Tumors of he penis (chapter 31). Campbell-Walsh Urology, 9th edn. Saunders, Philadelphia, pp 959–992Google Scholar
  10. 10.
    Solsona E, Algaba F, Horenblas S, Pizzocaro G, Windahl T (2004) EAU guidelines on penile cancer. Eur Urol 46:1–8PubMedCrossRefGoogle Scholar
  11. 11.
    Kroon BK, Horenblas S, Meinhardt W, van der Poel HG, Bex A, van Tinteren H, Valdes Olmos RA, Nieweg OE (2005) Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol 47:601–606PubMedCrossRefGoogle Scholar
  12. 12.
    Kroon BK, Valdes-Olmos RA, van Tinteren H, Nieweg OE, Horenblas S (2005) Reproducibility of lymphoscintigraphy for lymphatic mapping in patients with penile carcinoma. J Urol 174:2214–2217PubMedCrossRefGoogle Scholar
  13. 13.
    Spiess PE, Izawa JI, Bassett R, Kedar D, Busby JE, Wong F, Eddings T, Tamboli P, Pettaway CA (2007) Preoperative lymphoscintigraphy and dynamic sentinel node biopsy for staging penile cancer: Results with pathological correlation. J Urol 177:2157–2161PubMedCrossRefGoogle Scholar
  14. 14.
    Kroon BK, Horenblas S, Estourgie SH, Lont AP, Valdes Olmos RA, Nieweg OE (2004) How to avoid false-negative dynamic sentinel node procedures in penile carcinoma. J Urol 171:2191–2194PubMedCrossRefGoogle Scholar
  15. 15.
    Lont AP, Kroon BK, Gallee MP, van Tinteren H, Moonen LM, Horenblas S (2007) Pelvic lymph node dissection for penile carcinoma: extent of inguinal lymph node involvement as an indicator for pelvic lymph node involvement and survival. J Urol 177:947–952PubMedCrossRefGoogle Scholar
  16. 16.
    Bermejo C, Busby JE, Spiess PE, Heller L, Pagliaro LC, Pettaway CA (2007) Neoadjuvant chemotherapy followed by aggressive surgical consolidation for metastatic penile squamous cell carcinoma. J Urol 177:1335–1338PubMedCrossRefGoogle Scholar
  17. 17.
    Sobin LH, Wittekind C (1997) UICC International Union Against Cancer: Urological tumours. Wiley-Liss, New York, pp 187–201Google Scholar
  18. 18.
    Bevan-Thomas R, Slaton JW, Pettaway CA (2002) Contemporary morbidity from lymphadenectomy for penile squamous cell carcinoma: the M. D. Anderson Cancer Center Experience. J Urol 167:1638–1642PubMedCrossRefGoogle Scholar
  19. 19.
    Kamat MR, Kulkarni JN, Tongaonkar HB (1993) Carcinoma of the penis: the Indian experience. J Surg Oncol 52:50–55PubMedCrossRefGoogle Scholar
  20. 20.
    Josephs LG, Cordts PR, DiEdwardo CL, LaMorte WW, Menzoian JP (1993) Do infected inguinal lymph nodes increase the incidence of postoperative groin wound infection. J Vasc Surg 17:1077–1080PubMedCrossRefGoogle Scholar
  21. 21.
    Tonouchi H, Ohmori Y, Kobayashi M, Konishi N, Tanaka K, Mohri Y, Mizutani H, Kusunoki M (2004) Operative morbidity associated with groin dissections. Surg Today 34:413–418PubMedCrossRefGoogle Scholar
  22. 22.
    Qi F, Gu J, Shi Y (2008) Difficult groin reconstruction using contralateral rectus abdominis myocutaneous flap. Plast Reconstr Surg 121:147e–148ePubMedCrossRefGoogle Scholar
  23. 23.
    Evriviades D, Raurell A, Perks AG (2007) Pedicled anterolateral thigh flap for reconstruction after radical groin dissection. Urology 70:996–999PubMedCrossRefGoogle Scholar
  24. 24.
    Rayment R, Evans DM (1987) Use of an abdominal rotation flap for inguinal lymph node dissection. Br J Plast Surg 40:485–487PubMedGoogle Scholar
  25. 25.
    Abraham V, Ravi R, Shrivastava BR (1992) Primary reconstruction to avoid wound breakdown following groin block dissection. Br J Plast Surg 45:211–213PubMedCrossRefGoogle Scholar
  26. 26.
    Parkash S (1982) Use of myocutaneous flaps in block dissections of the groin in cases with gross skin involvement. Br J Plast Surg 35:413–419PubMedCrossRefGoogle Scholar
  27. 27.
    Bouchot O, Rigaud J, Maillet F, Hetet JF, Karam G (2004) Morbidity of inguinal lymphadenectomy for invasive penile carcinoma. Eur Urol 45:761–765PubMedCrossRefGoogle Scholar
  28. 28.
    Nelson BA, Cookson MS, Smith JA Jr, Chang SS (2004) Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series. J Urol 172:494–497PubMedCrossRefGoogle Scholar
  29. 29.
    Catalona WJ (1988) Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. J Urol 140:306–310PubMedGoogle Scholar
  30. 30.
    Zhang X, Sheng X, Niu J, Li H, Li D, Tang L, Li Q, Li Q (2007) Sparing of Saphenous vein during inguinal Lymphadenectomy for vulvar malignancies. Gynecol Oncol 105:722–726PubMedCrossRefGoogle Scholar
  31. 31.
    Magri K, Bertrand V, Sautiere JL, Pivot X, Riethmuller D, Maillet R, Marinkovic Z (2006) Cost effectiveness of Ligasure Precise versus surgical clips during axillary nodal dissection for breast cancer. J Gynecol Obstet Reprod (Paris) 35:341–347Google Scholar
  32. 32.
    Adwani A, Ebbs SR (2006) Ultracision reduces acute blood loss but not seroma formation after mastectomy and axillary dissection: a pilot study. Int J Clin Pract 60:562–564PubMedCrossRefGoogle Scholar
  33. 33.
    Garfein ES, Borud LJ, Warren AG, Slavin SA (2008) Learning from a lymphedema clinic: an algorithm for the management of localized swelling. Plast Reconstr Surg 121:521–528PubMedCrossRefGoogle Scholar
  34. 34.
    Warren AG, Brorson H, Borud LJ, Slavin SA (2007) Lymphedema: a comprehensive review. Ann Plast Surg 59:464–472PubMedCrossRefGoogle Scholar
  35. 35.
    Malone PC, Agutter PS (2006) The aetiology of deep venous thrombosis. QJM 99:581–593PubMedCrossRefGoogle Scholar
  36. 36.
    Ettema HB, Kollen BJ, Verheyen CC, Buller HR (2008) Prevention of venous thromboembolism in patients with immobilization of the lower extremity: a meta-analysis of randomized controlled trials. J Thromb Haemost 6(7):1093–1098Google Scholar
  37. 37.
    Sawchuk IS, Williams D, Chang DT (2002) Low molecular weight heparin for venous thromboembolism prophylaxis in urologic oncologic surgery. Cancer Invest 20:889–892CrossRefGoogle Scholar
  38. 38.
    Kroon BK, Lont AP, Valdes Olmos RA, Nieweg OE, Horenblas S (2005) Morbidity of dynamic sentinel node biopsy in penile carcinoma. J Urol 173:813–815PubMedCrossRefGoogle Scholar
  39. 39.
    Tobias-Machado M, Tavares A, Ornellas AA, Molina WR Jr, Juliano RV, Wroclawski ER (2007) Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 177:953–957PubMedCrossRefGoogle Scholar
  40. 40.
    Sotelo R, Sanchez-Salas R, Carmano O, Garcia A, Mariano M, Neiva G, Trujillo G, Novoa J, Cornejo F, Finelli A (2007) Endoscopic lymphadenectomy for penile carcinoma. J Endourol 21:364–367PubMedCrossRefGoogle Scholar
  41. 41.
    Lopes A, Hidalgo GS, Kowalski LP, Torlani H, Rossi BM, Fonseca FP (1996) Prognostic factors in carcinoma of the penis: multivariate analysis of 145 patients treated with amputation and lymphadenectomy. J Urol 156:1637–1642PubMedCrossRefGoogle Scholar
  42. 42.
    Darai E, Karaitianos I, Durand JC (1988) Treatment of inguinal lymph nodes in cancer of the penis. Apropos of 85 cases treated at the Institute Curie. Ann Chir 42:748–752PubMedGoogle Scholar
  43. 43.
    Ayyappan K, Ananthakrishnan N, Sankaran V (1994) Can regional lymph node involvement be predicted in patients with carcinoma of the penis? Br J Urol 73:549–553PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Philippe E. Spiess
    • 1
  • Mike S. Hernandez
    • 2
  • Curtis A. Pettaway
    • 3
    Email author
  1. 1.H. Lee Moffitt Cancer Center & Research InstituteTampaUSA
  2. 2.Division of Quantitative SciencesThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Departments of Urology and Cancer BiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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