Radio-guided lymph node surgery in urethral and penile cancer

Purpose: At the end of the 1970s, Cabanas postulated the existence of repro ducible sentinel lymph nodes (SLN) located medial to the saphenofemoral jun ction by means of lymphangiography. The lack of reproducibility of SLN in p enile carcinoma as to its defined localization was later emphasized by nume rous investigations in which patients with gross lymphatic metastases could be monitored despite negative biopsies of the "Cabanas lymph node". The hi gh morbidity of inguinal lymphadenectomy and the individual variability reg arding the location of SLN justified the necessity for a technique which en ables identification of these nodes. It was the aim of this study to determine whether preoperative lymphoscinti graphy and intraoperative gamma probe-guided lymph node detection was able to identify the SLN. Material and methods: Since 1998, SLN were identified intraoperatively and selectively dissected in 6 patients with penile or urethral cancer after pe ritumoral injection of technetium-99m nanocolloid and performance of lympho scintigraphy. Results: At least one SLN could be detected in each patient. The maximum su rgical time for sentinel lymphadenectomy was 30 minutes. There were no seve re complications. Lymph node metastases were found in one patient in one se ntinel lymph node. After a mean follow-up of 16 months, all patients are cu rrently tumor-free. Conclusions: Due to the long-term results of sentinel lymphadenectomy in ma lignant melanoma of other locations and our preliminary results in urethral and penile cancer, we consider this method to be appropriate as the only p rimary operation for lymph node staging in early stages and, in combination with modified inguinal lymphadenectomy, in locally advanced stages.