Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique.

PURPOSE: To describe our surgical technique and report the oncological outcomes and complication rates using a fascial-sparing radical inguinal lymphadenectomy (RILND) technique for penile cancer patients with cN+ disease in the inguinal lymph nodes. METHODS: Over a 10-year period, 660 fascial-sparing RILND procedures were performed in 421 patients across two specialist penile cancer centres. The technique used a subinguinal incision with an ellipse of skin excised over any palpable nodes. Identification and preservation of the Scarpa's and Camper's fascia was the first step. All superficial inguinal nodes were removed en bloc under this fascial layer with preservation of the subcutaneous veins and fascia lata. The saphenous vein was spared where possible. Patient characteristics, oncologic outcomes and perioperative morbidity were retrospectively collected and analysed. Kaplan-Meier curves estimated the cancer-specific survival (CSS) functions after the procedure. RESULTS: Median (interquartile range, IQR) follow-up was 28 (14-90) months. A median (IQR) number of 8.0 (6.5-10.5) nodes were removed per groin. A total of 153 postoperative complications (36.1%) occurred, including 50 conservatively managed wound infections (11.9%), 21 cases of deep wound dehiscence (5.0%), 104 cases of lymphoedema (24.7%), 3 cases of deep vein thrombosis (0.7%), 1 case of pulmonary embolism (0.2%), and 1 case of postoperative sepsis (0.2%). The 3-year CSS was 86% (95%Confidence Interval [95% CI] 77-96), 83% (95% CI 72-92), 58% (95% CI 51-66), respectively, for the pN1, pN2 and pN3 patients (p < 0.001), compared to a 3-year CSS of 87% (95% CI 84-95) for the pN0 patients. CONCLUSION: Fascial-sparing RILND offers excellent oncological outcomes whilst decreasing the morbidity rates. Patients with more advanced nodal involvement had poorer survival rates, emphasizing the need for adjuvant chemo-radiotherapy.

Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes.

PURPOSE: We reviewed our recent experience with inguinal lymph node dissection in patients with penile cancer to assess the incidence and magnitude of complications caused by this procedure. MATERIALS AND METHODS: Radical bilateral inguinal lymphadenectomy was performed in 170 patients (340 procedures). Prophylactic and therapeutic radical inguinal lymphadenectomy was done in 67 (39.4%) and 103 patients (60.6%), respectively. Operative time and length of hospital stay were examined. Complications were divided into minor and major, and early (30 days or less after surgery) and late (greater than 30 days), and analyzed. RESULTS: A total of 35 complications (10.3%) were observed, of which 25 (71.4%) were minor and 10 (28.6%) were major. We noted lymphedema in 14 patients (4.1%), seroma in 4 (1.2%), scrotal edema in 3 (0.9%), skin edge necrosis in 3 (0.9%), lymphocele in 3 (0.9%), wound infection in 2 (0.6%), flap necrosis in 2 (0.6%), wound abscess in 2 (0.6%) and deep venous thrombosis in 2 (0.6%). There was no significant difference in complication rates between patients treated with prophylactic vs therapeutic dissection. Mean hospital stay was 6.4 days (range 4 to 27). Average operative time for radical unilateral inguinal lymphadenectomy was 94 minutes. CONCLUSIONS: Our contemporary series includes a lower incidence of complications, such as wound infection, skin flap necrosis, lymphocele and lymphedema. To our knowledge this series represents the lowest incidence rate of complications described in the international literature.

Video endoscopic inguinal lymphadenectomy for radical management of inguinal nodes in patients with penile squamous cell carcinoma.

BACKGROUND: Inguinal lymph node involvement is an important prognostic factor in penile cancer. Inguinal lymph node dissection allows staging and treatment of inguinal nodal disease. However, it causes morbidity and is associated with complications such as lymphocele, skin loss, and infection. AIMS: To report our institutional experience with video endoscopic inguinal lymphadenectomy (VEIL) for radical management of inguinal nodes in patients with penile squamous cell carcinoma. MATERIALS AND METHODS: It is a prospective analysis of data of patients that underwent VEIL, by a single surgeon, from 2008 to 2015. 14 patients of penile carcinoma were suitable for VEIL technique were included in this study and followed. Data analyzed included mean operative time, mean lymph node yield, intraoperative complications, cutaneous complication, lymph-related complications, and surgical emphysema. RESULTS: The mean age of patients was 57.8 years (range: 45-70 years). Mean operative time for VEIL was 194.86 min (178-210 min). Mean lymph node yield was 7.68 (range: 5-11 nodes). No intraoperative complication was experienced during series. We noted no cutaneous complications, localized lymphocele were seen in total 6 units out of 22 units (27.2%). Surgical emphysema is seen in 3 limbs (13.63%). There was significantly decreased overall morbidity in our study. Follow-up of 10 out of 14 patients with median of 48 months shows no recurrence. CONCLUSIONS: In our early experience, VEIL is a safe and feasible technique in patients with penile carcinoma who require radical inguinal lymphadenectomy. It allows the removal of inguinal lymph nodes within the same limits as in conventional surgical dissection and reduces surgical morbidity substantially.