The Presentation
A man was referred with Penile Cancer. After the primary tumour had been assessed and the cancer staged, the key remaining question was the lymph nodes in the groins. In Penile Cancer, these are almost always the first place the disease spreads, and his tumour features placed him at significant risk of spread that scans alone could not rule out.
Why This Case Was Complex
- Both groins needed treatment. Penile Cancer can drain to either side, so lymph nodes had to be removed from both groins in the same treatment.
- Open groin surgery has a hard recovery. Conventional inguinal lymph node dissection uses long incisions in a region prone to wound breakdown, infection and leg swelling.
- Scans cannot see microscopic spread. Only removing and examining the nodes gives a reliable stage, which decides whether further treatment is needed.
The Approach
After a full discussion of the options, Dr. Anshuman Singh performed a bilateral robotic video-endoscopic inguinal lymphadenectomy (robotic VEIL). Working through a few small incisions on each side, with a magnified three-dimensional view and wristed robotic instruments, the same lymph node tissue removed in an open operation was cleared from both groins, while the skin over the groin was left intact.
The Outcome
- Accurate staging: the final pathology was pT2 N1, confirming spread to the regional lymph nodes, with clear surgical margins.
- Smooth recovery: the patient was up and walking early and recovered without the wound problems that often follow open groin surgery.
- A clear plan ahead: with the nodes properly staged, decisions about surveillance and any additional treatment could be made on solid information. He remains under regular follow-up.
Key Takeaways for Patients
- In Penile Cancer, managing the groin lymph nodes matters as much as treating the visible tumour.
- Not every patient needs lymph node surgery. The decision depends on the tumour's stage and grade and on the examination and scans.
- When groin surgery is needed, minimally invasive VEIL can achieve the same removal with a far easier recovery for suitable patients.
- A sore or growth on the penis that does not heal within a few weeks should be examined, not repeatedly treated as an infection.
Read more about Penile Cancer and robot-assisted surgery.
Every patient is different. This case describes one patient's treatment and is not a guarantee of similar results. It is shared for education, with the patient's consent and without identifying details.