Introduction:

Lower extremity lymphedema is a common and morbid complication after inguinal lymph node dissection for penile cancer. Creation of lymphaticovenous bypass(es) is a microsurgical technique performed immediately following lymph node dissection to prevent lymphedema. This reconstructive modality has not been utilized following lymph node dissection for penile cancer. Herein, we present a case series of 10 inguinal lymph node dissections in 5 patients who underwent immediate lymphatic reconstruction with lymphaticovenous bypass after bilateral lymph node dissection for penile cancer.

Methods:

5 consecutive patients with pT2 or pT3 penile cancer underwent open bilateral superficial lymph node dissection in the standard fashion (Figure 1). Bilateral prophylactic lymphaticovenous bypasses were successfully created in the same operation. A standard lymphatic mapping technique was performed using dual fluorescent dyes (indocyanine green and fluorescein). Identified lymphatic channels were then bypassed to local recipient veins in the surgical field by creating end-to-end anastomoses between the vessels. Patients were evaluated post-operatively at weeks 1, 2, 3, and 6, and then quarterly thereafter.

Results:

Baseline characteristics and results are summarized in Table 1. Mean age was 59.2, and mean length of surgery (from incision to closure) was 375.4 minutes. Mean number of microsurgical lymphatic bypasses created was 2.4 per each side. An average of 8.6 lymph nodes were identified per each dissection. On final pathology, all nodes were negative for metastases in all patients. All patients were discharged on postoperative day #1. Mean length of follow-up was 191.4 days. Closed suction drains were removed when daily effluent volumes had appropriately tapered, and all drains had been removed on average of 43.4 days postoperatively. 9/10 dissections had no significant lymphedema post-operatively. 1 patient underwent bilateral inguinal exploration and washout via subtotal incisions for fluid collections at the incision sites on post-operative day #18 with subsequent resolution of symptoms, however did not experience any lymphedema.

Conclusion:

Herein, we present a series of 10 successful immediate lymphatic reconstruction (ILR) cases after inguinal LND for penile cancer. A majority of inguinal lymph node dissections did not result in lymphedema postoperatively with minimal post-operative complications. ILR has been performed safely for a number of histological diagnoses but, to date, is not applied in treating penile cancer. Long-term follow-up in a larger cohort of patients is needed.

Funding: N/A