Technical considerations to minimize complications of inguinal lymph node dissection

Penile cancer is a rare malignancy with an annual incidence of less than one in 100,000 men worldwide (1). The presence of inguinal adenopathy is a likely indication of metastatic disease as the earliest site of regional dissemination of penile cancer is the superficial and deep inguinal nodes followed by the pelvic lymph nodes, including the external and internal iliac nodes (2). However, metastatic disease to the groin can be present without palpable inguinal lymph nodes. In both circumstances meaning palpable and nonpalpable adenopathy, groin lymphadenectomy has become the procedure of choice as a diagnostic and therapeutic modality. Current guidelines recommend inguinal lymphadenectomy in patients with penile cancer for palpable inguinal lymph nodes or in the event of nonpalpable lymph nodes where pathologic stage T2 or greater, the presence of lymphovascular invasion, or poorly differentiated histology (3). However, this procedure carries great morbidity and current literature estimates complication rates greater than 50% for radical inguinal lymphadenectomy (4). The most common complications are lymphedema, deep venous thrombosis (DVT), wound infection, skin necrosis, lymphocele, and seroma (5). Our aim is to identify complications of inguinal lymphadenectomy that may be minimized with modifications in surgical approach