[The significance of inguinal lymphadenectomy in carcinoma of the penis].

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 (99)Tc 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.