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Die Bedeutung der inguinalen Lymphadenektomie beim Peniskarzinom

The significance of inguinal lymphadenectomy in carcinoma of the penis

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Zusammenfassung

Das Auftreten von inguinalen Lymphknotenmetastasen beim Plattenepithelkarzinom des Penis ist abhängig von der lokalen Tumorausdehnung, vom Tumorgrad und der Gefäßinvasion. Obwohl durch Bildgebung und Feinnadelbiopsie der Nachweis der inguinalen Lymphkontenmetastasen möglich ist, bleibt, die diagnostische Maßnahme der Wahl die Resektion der oberflächlichen inguinalen Lymphknoten.

Die Indikation zur modifizierten Lymphadenektomie bei palpatorisch unauffälligen Lymphknoten erfolgt entsprechend des Risikoprofils welches in den Richtlinien der EAU festgelegt wurde. Die Entfernung der durch 99Tc und Farbstoff markierten Sentinel-Lymphknoten als Alternative dazu ist derzeit noch nicht ausreichend untersucht, um als Standardmethode für die Diagnostik zu gelten. Sind die oberflächlichen inguinalen Lymphknoten metastatisch befallen, erfolgt in weiterer Konsequenz die bilaterale radikale Lymphadenektomie. Liegen 2 Lymphknotenmetastasen oder extranodales Tumorwachstum vor oder sind in der Bildgebung vergrößerte Lymphknoten im kleinen Becken nachweisbar, werden auch die pelvinen Lymphknoten entfernt.

Bei entsprechender operativer Technik und postoperativer Nachsorge ist die Komplikationsdichte gering, insbesondere ist das persistierende Lymphödem der Beine eine Seltenheit. Chemotherapie, Radiotherapie oder die Kombination beider Modalitäten sind hinsichtlich ihrer Effektivität nicht überprüft und werden individuell in Abhängigkeit von der lokalen Ausdehnung prä- und postoperativ eingesetzt.

Abstract

The occurrence of inguinal lymph node metastases from squamous cell carcinoma of the penis depends on local tumor extension, tumor grade, and vascular invasion. Whilst imaging techniques and fine needle biopsy can detect metastases to the inguinal nodes, resection of the superficial inguinal nodes remains the procedure of choice for diagnosis.

The risk profile defined in the guidelines of the EAU is used to decide whether modified inguinal lymphadenectomy is indicated in the case of nonpalpable lymph nodes. Resection of the sentinel lymph node marked by 99Tc and dye has not yet been adequately evaluated as an alternative to be accepted as the standard method.

When the superficial inguinal lymph nodes are found to harbor metastases the next step is a radical bilateral inguinal lymphadenectomy. When metastases are found in two lymph nodes or extranodal tumor growth is observed, or imaging techniques reveal enlarged nodes in the pelvis the lymphadenectomy is extended to the pelvic nodes. With appropriate surgical technique and postoperative care the complication rate is low; in particular, persistent lymphedema of the legs is rarely observed. Chemotherapy and radiotherapy and the two combined have not been tested for efficacy, but are used individually before and after surgery, depending on the local tumor extent.

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  1. Urologische Klinik, Universitätsklinikum, Rhein-Westfälische Technische Hochschule, Pauwelsstraße 30, 50072, Aachen, Deutschland

    E. Preis &  G. Jakse

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  1. E. Preis
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  2. G. Jakse
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Correspondence to G. Jakse.

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Preis, E., Jakse, G. Die Bedeutung der inguinalen Lymphadenektomie beim Peniskarzinom. Urologe 45 (Suppl 4), 176–180 (2006). https://doi.org/10.1007/s00120-006-1176-6

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