The diagnosis of occult inguinal lymph node metastasis in clinically node-negative invasive penile squamous cell carcinoma (PSCC) has remained a challenge, with substantial perioperative complications. The recent refinements in the technique of dynamic sentinel lymph node biopsy (DSLNB) demonstrated high diagnostic accuracy with considerably lower morbidity compared to conventional open modified/superficial inguinal lymph node dissection (ILND). Although DSLNB, if available, has been endorsed as the preferred method for nodal staging in patients with invasive PSCC and no palpable inguinal lymphadenopathy in the recent penile cancer guidelines, its utilization has been quite limited so far. Laparoscopic and robotic-assisted ILND have emerged as alternatives for nodal staging in this patient population and are shown to improve the rate of wound infections and postoperative pain. For management of nodal metastasis in patients with clinically palpable inguinal lymph nodes, minimally invasive ILND has shown promising results as well. Nonetheless, given the rarity of PSCC and the absence of prospective studies and clinical trials, nodal staging and treatment of nodal metastasis in clinical practice will likely continue to vary across the medical centers in the following years. In this review, we first summarize the evolution of DSLNB and minimally invasive ILND and discuss the advantages and drawbacks of each management strategy. We further discuss the remaining challenges and future perspectives in the management of inguinal lymph nodes in patients with PSCC.
临床上淋巴结阴性的浸润性阴茎鳞状细胞癌（PSCC）中隐匿性腹股沟淋巴结转移的诊断一直是个挑战，且伴随显著的围手术期并发症。动态前哨淋巴结活检（DSLNB）技术的最新改进显示，与传统开放式改良/浅表腹股沟淋巴结清扫术（ILND）相比，其诊断准确性高且并发症发生率显著降低。尽管在最新的阴茎癌指南中，若条件允许，DSLNB已被推荐为无触诊腹股沟淋巴结肿大的浸润性PSCC患者淋巴结分期的首选方法，但迄今为止其应用仍相当有限。腹腔镜和机器人辅助ILND已成为该患者群体淋巴结分期的替代选择，并显示出可降低伤口感染率和术后疼痛。对于临床上可触及腹股沟淋巴结转移的患者，微创ILND也显示出良好的治疗效果。然而，鉴于PSCC的罕见性以及缺乏前瞻性研究和临床试验，未来几年临床实践中淋巴结分期和淋巴结转移的治疗在不同医疗中心可能仍存在差异。本文首先总结了DSLNB和微创ILND的发展历程，并讨论了每种治疗策略的优缺点。我们进一步探讨了PSCC患者腹股沟淋巴结管理中仍面临的挑战和未来展望。
肿瘤(癌症)患者之家