Editing EAU & ASCO: Penile Cancer 2023 (section)

===== Radical inguinal lymph node dissection =====
* '''Standard of care for patients with cN1–2 (or cN0 patients with a tumour positive sentinel node at DSNB)'''
* No widespread adoption of lymph node yield or density as quality marker
* '''Adverse events'''
** '''Significant morbidity due to impaired lymph drainage from the legs and scrotum'''
*** '''Overall complication rate: 21–55%'''
*** '''Most common complications''' 
**** '''Wound infections (2–43%)'''
**** '''Skin necrosis (3–50%)'''
**** '''Lmphoedema (3.1–30%)'''
**** '''Lymphocele formation (1.8–26%)'''
**** '''Seroma (2.4–60%)'''
* '''Approaches (2)'''
*# '''Open'''
*#* '''Standard for cN1–2 disease'''
*#** In patients with cN1 disease offer either ipsilateral:
*#*** Fascial-sparing inguinal lymph node dissection (ILND)
*#*** Open radical ILND; sparing the saphenous vein, if possible
*#** In patients with cN2 disease offer ipsilateral open radical ILND; sparing the saphenous vein, if possible
*# '''Minimally-invasive'''
*#* Offer minimally-invasive ILND to patients with cN1–2 disease only as part of a clinical trial.
*#* Although operative time is longer, LN yields can be similar to open ILND, length of hospital stay shorter in VEIL/RAVEIL and wound complications lower, though lymphocele and readmission rates were equivalent