Robotic inguinal lymphadenectomy for penile cancer: the why, how, and what

Squamous cell carcinoma of the penis (SCC-P) is rare malignancy in the United States, with an estimated incidence of less than 2,000 cases per year and less than 300 mortalities per year (Siegel 2016). Critical to the evaluation and management of SCC-P, however, is clear assessment of the inguinal lymph nodes for potential involvement. This is performed with a physical examination, in cases with difficult examination imaging evaluation. Standard care for inguinal involvement of regional lymph nodes is surgical excision when feasible (1-3). While not all palpable or enlarged lymph nodes are consistent with pathologic SCC-P nodal involvement (as some can be due to local infection and inflammation), delay in removal may result in progression to pelvic lymphadenopathy and non-regional metastatic disease which is associated with poor survival (4). Further not all regional inguinal metastases are palpable and inguinal lymph dissection (ILND) his has been shown to be of clinical in the prophylactic setting where microscopic metastatic disease is possible (5,6)