Prophylactic lymphadenectomy vs observation vs inguinal biopsy in node-negative patients with invasive carcinoma of the penis.

From 1962 to 1984, 423 patients with invasive penile cancer and negative groin nodes were subjected to prophylactic lymphadenectomies (n113), observations (n258) or inguinal biopsies (n52) in a non-randomised fashion. The numbers of patients with T2, T3 and T4 lesions were similar in the three groups. The overall five-year disease-free survivals were 94, 93 and 85%, respectively. All groin recurrences in the observation group occurred within 18 months of the surgery for the primary tumor. The five-year disease-free survivals of node-positive patients in the lymphadenectomy and observation groups were 100 and 76%, respectively; three patients in the latter group had refused surgical treatment when their adenopathy was mobile. Morbidity from the prophylactic lymphadenectomies included wound breakdown in 61%, wound infection in 18% and lymphedema in 25% of patients. We feel that neither prophylactic lymphadenectomy nor inguinal biopsy are justified in these patients. Close observation of the groin nodal status would be appropriate.