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Review
. 2025 Nov 19.
doi: 10.1007/s11255-025-04911-6. Online ahead of print.

Penile cancer and lymph node management: a call for standardization

Achille Aveta #  1 , Vincenzo Iossa #  2 , Gianluca Spena  1 , Roberto Contieri  1 , Alessandro Izzo  1 , Francesco Passaro  1 , Antonio Tufano  3 , Vittorio Imperatore  2 , Sisto Perdonà  1 , Lorenzo Romano  4 , Carlo Giulioni  5 , Angelo Cafarelli  5 , Pierluigi Russo  6   7 , Fabio Crocerossa  8 , Francesco Lasorsa  9 , Giuseppe Lucarelli  9   10 , Matteo Ferro  11 , Raffaele Balsamo  12 , Celeste Manfredi  4 , Davide Arcaniolo  4 , Salvatore Siracusano  13 , Savio Domenico Pandolfo  14   15
Affiliations
Review

Penile cancer and lymph node management: a call for standardization

Achille Aveta et al. Int Urol Nephrol. .

Abstract

Purpose: This study aims to compare and organize recommendations from the most eminent international guidelines on the staging and treatment of lymph node (LN) involvement in penile cancer (PC). Early recognition and appropriate management of nodal disease remain the cornerstone of care, influencing both survival and treatment-related morbidity.

Methods: This study compares and organize recommendations form the most eminent international guidelines-including NCCN, ESMO-EURACAN, and EAU-ASCO-on the staging and treatment of lymph node involvement in penile cancer.

Results: Open inguinal LN dissection (ILND) remains the standard treatment for not superficial cancers and its morbidity has driven interest in minimally invasive surgical approaches, such as video-endoscopic inguinal lymphadenectomy (VEIL), including its robot-assisted variant (RA-VEIL). Their role is well defined in clinically node-negative (cN0) patients but remains investigational in node-positive (cN+) cases. For cN3 disease and pelvic node involvement, multimodal strategies including chemotherapy, surgery, and radiotherapy are required.

Conclusion: The variability among guidelines underscores the need for collaborative efforts and high-quality prospective trials to refine and standardize treatment recommendations.

Keywords: Inguinal lymph node dissection; Lymph node management; Penile cancer; penile cancer guidelines.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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