From the Guidelines
Treatment for inguinal lymph nodes should be guided by the underlying cause, with a focus on minimizing morbidity, mortality, and improving quality of life, and according to the most recent guidelines, patients with cN1 disease should be offered either ipsilateral fascial-sparing inguinal lymph node dissection (ILND) or open radical ILND, sparing the saphenous vein, if possible 1. When considering treatment options, it is essential to evaluate the patient's overall health, the severity of symptoms, and the potential risks and benefits of each approach.
- For patients with palpable inguinal lymph nodes, fine-needle aspiration or excisional biopsy may be necessary to determine the underlying cause, as recommended by the NCCN Guidelines 1.
- In cases where malignancy is suspected, referral to an oncologist for further evaluation and treatment, including chemotherapy, radiation, or surgical intervention, is crucial 1.
- The use of antibiotics, such as amoxicillin-clavulanate or cephalexin, may be indicated for bacterial infections causing lymphadenopathy, while doxycycline or ceftriaxone may be prescribed for sexually transmitted infections 1.
- Warm compresses and over-the-counter pain relievers, like acetaminophen or ibuprofen, can help alleviate discomfort and reduce inflammation in patients with mild, non-specific lymphadenopathy. The management of inguinal lymph nodes requires a comprehensive approach, taking into account the patient's individual needs and the most recent clinical guidelines, as outlined in the European Association of Urology-American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update 1.
From the Research
Inguinal Lymph Node Dissection
- Inguinal lymph node dissection (ILND) is a critical step in the treatment and staging of various malignancies, including penile and vulvar cancers 2, 3.
- The goal of ILND is to remove the lymph nodes in the inguinal region, which can help to prevent the spread of cancer to other parts of the body 2.
- There are different surgical approaches available for ILND, including open, video endoscopic, and robotic-assisted techniques 3.
Surgical Techniques
- Modified ILND can be safely performed for patients with nonpalpable nodes, while diagnostic sentinel node biopsy is a good alternative in centers with experience 2.
- Minimally invasive ILND has gained popularity in recent years, with favorable results at short-term follow-up 3.
- Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield as open techniques, while minimizing postoperative complications 3.
Postoperative Complications
- ILND can be associated with significant postoperative complications, including wound dehiscence, necrosis, and infection 3, 4.
- Recent refinements in surgical technique and appropriate patient selection can help to minimize these risks and lead to better short-term and long-term outcomes 4.
- Certain lymph node characteristics, such as large lymph node size and perinodular fat stranding, can be predictive of limb amputation in patients with ischemic foot ulcers after endovascular treatment 5.
Treatment Outcomes
- Early upfront surgery appears to be the best approach for men with early involvement of the inguinal lymph nodes, while systemic therapy is typically reserved for higher volume disease 2.
- Clinical trial enrollment is a priority to garner more evidence-based recommendations for the treatment of inguinal lymph node cancer 2.
- Appropriate management of the lymph nodes is critical and has been shown to impact survival for patients with penile cancer 2.