Penile carcinoma: The case for primary lymphadenectomy

Abstract

Carcinoma of the penis remains a disease that is curable only when complete surgical excision is possible. Even the most aggressive attempts to control this disease with cytotoxic chemotherapy and radiation have met with dismal results. On the other hand, the surgery necessary to eradicate this disease is both mutilating and morbid. The combination of these factors has led many to take a nonaggressive approach to the management of these patients. Much of the confusion regarding the management of penile carcinoma stems from the lack of a generally accepted clinical staging system. Most reports have employed some modification of the staging system originally published by Jackson in 1966 [1]. This staging system was a retrospective pathological classification that has been extrapolated to the clinical setting. Unfortunately, the correlation between clinical stage and pathological stage has been shown repeatedly to be quite poor in this disease [2]. In addition, the original Jackson staging system did not distinguish between superficial and invasive lesions. Instead, a distinction was made between tumors confined to the glans or prepuce and those extending onto the shaft of the penis. Thus, reports utilizing the Jackson staging system are difficult to extrapolate to patient management decisions. This is particularly the case in deciding who should and who should not undergo lymphadenectomy.