The case for inguinal lymph node dissection in the treatment of T2-T4, N0 penile cancer.

The battle for the control of squamous cell carcinoma of the penis is either won or lost at the level of the inguinal lymph nodes. Few patients die of distant metastasis without prior development of ilioinguinal nodal disease. If death or recurrence does occur, it does so typically within 2 years. In clinical stage T2-T4, N0 disease, there is a high risk of nodal involvement. In those patients with positive nodes, lymphadenectomy can be curative. It is apparent that forms of therapy other than a surgical approach are distinctly inferior. Awaiting the development of nodal metastasis carries the risk of a significantly lower survival time. Unfortunately, highly sensitive and specific forms of preoperative staging do not exist. With current techniques, ILND can be accomplished with minimal morbidity. For these reasons, it is recommended that all patients with clinical T2-T4, N0 squamous cell carcinoma of the penis undergo immediate inguinal lymphadenectomy.