Patient selection: penile cancer
Parameters:
(1) number of left inguinal lymph nodes with metastatic cancer
(2) number of right inguinal lymph nodes with metastatic cancer
(3) extranodal extension (ENE) in left inguinal lymph nodes
(4) extranodal extension (ENE) in right inguinal lymph nodes
(5) highly suspicious lymph node changes in left pelvic lymph nodes on imaging studies
(6) highly suspicious lymph node changes in right pelvic lymph nodes on imaging studies
Bilateral pelvic lymphadenectomy is performed if:
(1) there metastases to both left and right inguinal lymph nodes
(2) there is either:
(2a) total number of lymph nodes >= 4
(2b) there is bilateral extranodal extension
If there is bilateral disease and these criteria are not met, then:
(1) there is a left pelvic lymphadenectomy if unilateral criteria are met
(2) there is a right pelvic lymphadenectomy if unilateral criteria are met
Unilateral criteria (best evidence) – one or more of the following:
(1) >= 3 ipsilateral inguinal lymph nodes with metastases (guidelines use >= 2)
(2) extranodal extension
(3) highly suspicious lymph node changes on pelvic imaging
