title: Patients with penile carcinoma benefit from immediate resection of clinically occult lymph node metastases.
abstract: OBJECTIVE
  In this retrospective study we compared the clinical outcome of early vs delayed excision of lymph node metastases in patients with penile squamous cell carcinoma.
  
  
  METHODS
  A total of 40 patients with a T2-3 penile carcinoma with lymph node metastases were included in this study. All patients initially presented with bilateral impalpable lymph nodes. In 20 patients (50%) metastases were removed when they became clinically apparent during meticulous followup (median interval 6 months, range 1 to 24). There were 20 patients (50%) who underwent resection of inguinal metastases detected on dynamic sentinel node biopsy before they became palpable. The histopathological characteristics of the tumors and lymph nodes were reevaluated.
  
  
  RESULTS
  The 2 populations were similar in terms of patient age, T-stage, pathological tumor grade, vascular invasion and infiltration depth. Disease specific 3-year survival of patients with positive lymph nodes detected during surveillance was 35% and in those who underwent early resection, 84% (log rank p = 0.0017). In multivariate analysis early resection of occult inguinal metastases detected on dynamic sentinel node biopsy was an independent prognostic factor for disease specific survival (p = 0.006).
  
  
  CONCLUSIONS
  Early resection of lymph node metastases in patients with penile carcinoma improves survival.
authors.affiliation: Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: B K
authors.initials: BK
authors.lastname: Kroon
authors.forename: S
authors.initials: S
authors.lastname: Horenblas
authors.forename: A P
authors.initials: AP
authors.lastname: Lont
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: M P W
authors.initials: MP
authors.lastname: Gallee
authors.forename: O E
authors.initials: OE
authors.lastname: Nieweg
mesh_terms: D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors