Role of laparoscopic pelvic lymph node dissection in the management of patients with penile cancer and inguinal adenopathy.

Patients with invasive squamous cell carcinoma of the penis and tumor involvement of the inguinal nodes are at risk for pelvic lymph node metastases. When this spread occurs, the chance for patient survival is limited. Because the sensitivity of CT in detecting pelvic lymph node metastases is low, open surgical pelvic lymphadenectomy is frequently performed. We have utilized laparoscopic pelvic lymphadenectomy as a minimally invasive alternative to this open approach in three patients with Stage T3 (UICC staging system) squamous cell carcinoma of the penis who had persistent inguinal adenopathy after a standard course of postpenectomy antiobiotic therapy. There were no intraoperative or postoperative complications, and all patients were discharged within 24 hours after surgery. The mean number of nodes removed was eight, and all specimens were free of tumor. Laparoscopic pelvic lymphadenectomy should be considered in patients with persistent inguinal adenopathy after antibiotic therapy before proceeding with inguinal lymph node dissection.