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Abstract
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Background and Aims Advanced penile cancer surgical and anesthetic approach are complex, leading to a difficult differential diagnosis of complications, namely between neuraxial anesthetic technique, positioning and surgical approach.
Methods Description of the perioperative anesthetic management and post-operative differential diagnosis of complications of a glansectomy with bilateral inguinal and pelvic lymphadenectomy. Informed consent for case publication was obtained.
Results A 51-year-old male, ASA III, diagnosed with stage IV penile carcinoma, underwent glansectomy with bilateral inguinal and pelvic lymphadenectomy. Medical history consisted of heavy ex-smoking and obesity. The 11-hour surgery occurred in dorsal decubitus with leg abduction, under ASA standard monitorization and arterial catheterization with serial blood gas analysis (Tables 1-2). Intravenous general anesthesia was combined with epidural analgesia (catheter placed at L3-L4). Post-operatively, the patient developed excruciating pain, sensitive-motor deficits in the right leg and foot paleness, raising uncertainty about the correct complication diagnosis. Differential diagnosis (Table 3) allowed an early suspected diagnosis. CT-scan confirmed a right femoral ischemia, leading to an urgent transfemoral thromboembolectomy. The patient remained hospitalized under Unfractionated Heparin (UFH) perfusion, epidural analgesia with morphine and ropivacaine 0.2% - with an 2/10 EVA pain score - and physical rehabilitation. After 4 days, UFH was stopped and epidural catheter removed. The patient was discharged 11 days later, with full clinical recovery.
Conclusions Postoperative femoral ischemia after penile cancer surgery was promptly diagnosed and treated, which confirms a thorough differential diagnosis is crucial to manage anesthetic or surgical complications effectively. This case underscores the need for standardization of anesthetic care and vigilant postoperative monitoring.
Inguinal approach for lymphadenectomy