title: Prospectively packaged ilioinguinal lymphadenectomy for penile cancer: the disseminative pattern of lymph node metastasis.
abstract: OBJECTIVE
  We prospectively evaluated the disseminative pattern of lymph node metastasis in penile cancer cases using packaged lymphadenectomy. In addition, we analyzed prognostic factors of the extent of lymph node metastasis.
  
  
  METHODS
  Packaged inguinal lymphadenectomy was performed in 46 patients. A total of 24 patients with 1 or more positive inguinal lymph nodes underwent packaged iliac lymphadenectomy. Inguinal lymphadenectomy was divided into 3 packages, including medial inguinal, lateral inguinal and Cloquet's node packages. Medial and lateral inguinal packages were separated by the lateral surface of the femoral artery and the saphenous vein. Iliac lymphadenectomy was divided into 3 packages, including external iliac, obturator and common iliac packages. Clinicopathological features of the primary tumor and lymph nodes were correlated with the extent of lymph node metastasis.
  
  
  RESULTS
  Of 92 groin basins 27 cases of inguinal lymphadenectomy and 7 of iliac lymphadenectomy had lymph node metastasis. Medial inguinal and external iliac packages were the most common involved regions in inguinal and iliac lymphadenectomy cases, respectively. No extended lymph node metastasis was observed in the absence of positive lymph nodes in the medial inguinal package. In groin basins with lymph node metastasis in the medial inguinal package extranodal extension was a significant predictor of extended lymph node metastasis. Cloquet's node was associated with iliac lymph node metastasis on univariate analysis. However, it was of limited predictive value in patients with 1 or 2 positive inguinal lymph nodes.
  
  
  CONCLUSIONS
  The medial inguinal package defined in our study was the first involved lymph node region in penile cancer cases. Extranodal extension was an important predictor of extended lymph node metastasis beyond the medial inguinal package.
authors.affiliation: Department of Urology, Cancer Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhu
authors.forename: Shi-Lin
authors.initials: SL
authors.lastname: Zhang
authors.forename: Ding-Wei
authors.initials: DW
authors.lastname: Ye
authors.forename: Xu-Dong
authors.initials: XD
authors.lastname: Yao
authors.forename: Bo
authors.initials: B
authors.lastname: Dai
authors.forename: Hai-Liang
authors.initials: HL
authors.lastname: Zhang
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Shen
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Zhu
authors.forename: Guo-Hai
authors.initials: GH
authors.lastname: Shi
authors.forename: Chun-Guang
authors.initials: CG
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods; D055815:Young Adult