Editing Inguinal Node Dissection (section)

== Anatomic Considerations ==

* '''See [[Anatomy: Groin and Inguinal|Groin and Inguinal Anatomy Chapter Notes]]'''
[[File:Femoral Triangle Anatomy.jpg|alt=Femoral triangle anatomy|thumb|509x509px|Femoral triangle anatomy. Source: [[commons:File:Femoral-triangle-diagram.jpg|Wikipedia]]]]

=== Penile Lymphatics ===
*'''<span style="color:#ff0000">Superficial lymphatic system</span>'''
**'''<span style="color:#ff0000">Drains the prepuce and skin of the penile shaft</span>'''
**'''<span style="color:#ff0000">Empties into the right and left superficial inguinal nodes</span>'''
*'''<span style="color:#ff0000">Deep lymphatic system</span>'''
**'''<span style="color:#ff0000">Drains the glans penis</span>'''
**'''<span style="color:#ff0000">Empties into the superficial inguinal nodes and the deep inguinal nodes</span>'''
*'''Primary site of metastatic spread of penile carcinoma occurs via the regional lymphatic system, first to the inguinal lymph node chain and then to the iliac and pelvic lymph nodes.'''
** '''Penetration of Buck’s fascia or the tunica albuginea by the primary penile tumor allows for dissemination of tumor cells into the lymphatic system'''
**Presence and extent of regional LN metastases is the single most important prognostic factor in determining the long-term survival of patients with penile cancer
***If cancer has spread to the pelvic nodes, long-term survival is < 10%
**'''Inguinal metastatic spread can be unilateral or bilateral'''
***Crossover drainage from the right to left groin or vice versa can also occur
**Metastatic spread from the inguinal lymph nodes to the contralateral pelvis or from the right to left pelvis has never been reported.
**'''Skip lesions with direct lymphatic drainage from penile tumors to the pelvic lymph nodes has never been reported.'''
**Further spread from the true pelvis to the retroperitoneal lymph nodes is beyond the regional drainage system of the penis and represents systemic metastatic disease