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Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis

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Abstract

Open inguinal lymph node dissection (O-ILND) is the gold standard in the management of lymph nodes in carcinoma penis; however, video endoscopic inguinal lymphadenectomy (VEIL) is performed in some centers. Our primary objective is to compare perioperative and survival outcomes in patients undergoing VEIL with O-ILND, as very few studies have reported long-term survival outcomes till date. We analyzed patients who underwent O-ILND and VEIL (laparoscopic or robot-assisted) from January 2009 to January 2020 in our institute for carcinoma of the penis. Patient details, perioperative complications, and survival outcomes were analyzed. Perioperative outcomes were analyzed by logistic regression and survival outcomes by log-rank and Cox regression methods. We analyzed 79 patients (32 O-ILND, 47 VEIL) with a median follow-up of 51 (IQR 25.5–75.5) and 42 months (IQR 21–62). Wound complications were common in O-ILND group (65.6%) compared to VEIL group (27.7%) (p = 0.001), predominantly skin flap necrosis in 14 groins (23.73%) after O-ILND and none after VEIL. Median overall survival was 80 and 88 months (p = 0.840) with five-year survival of 65% and 66.8% (p = 0.636) and five-year DSS of 76.6% and 73.9% (p = 0.96) in O-ILND and VEIL, respectively. Multivariate analysis showed that grade and pathological node status were significant (HR-2.650, p = 0.040; HR-3.218, p = 0.024) factors for survival. The retrospective nature of the study design is the limitation. Management of inguinal lymph nodes in carcinoma penis by VEIL is safe, associated with lesser wound-related complications, and equivalent survival outcomes compared to O-ILND. It should be considered as an alternative option for inguinal lymph node dissection.

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Authors and Affiliations

  1. Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Yuvaraja B. Thyavihally & Abhinav Pednekar

  2. Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Preetham Dev

  3. Uro-Oncology and Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Santosh S. Waigankar & Varun Agarwal

  4. Pathology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Bijal Kulkarni

  5. Nuclear Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Anshu Sharma

  6. Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Sharad Maheshwari

  7. Interventional Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Diptiman Roy

  8. Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Archan A. Khandekar, Naresh D. Badlani & Ashish N. Asari

  9. Clinical Statistics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India, 400053

    Neha Sanwalka

Authors
  1. Yuvaraja B. Thyavihally
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  2. Preetham Dev
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  3. Santosh S. Waigankar
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All authors critically revised the paper for important intellectual content. All authors have contributed to the work and agreed on the final version. This manuscript is not being considered by any other journal.

Corresponding author

Correspondence to Yuvaraja B. Thyavihally.

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Conflict of interest

Yuvaraja B Thyavihally, Preetham Dev, Santosh S Waigankar, Abhinav Pednekar, Bijal Kulkarni, Anshu Sharma, Sharad Maheshwari, Diptiman Roy, Varun Agarwal, Archan A Khandekar, Naresh D Badlani, Ashish N Asari, and Neha Sanwalka declare that they have no conflict of interest.

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All procedures performed in studies involving humans were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki declaration and its later amendments.

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Informed written consent for the surgery was obtained, but consent for inclusion in the study is not taken as it is a retrospective study.

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Thyavihally, Y.B., Dev, P., Waigankar, S.S. et al. Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis. J Robotic Surg 15, 905–914 (2021). https://doi.org/10.1007/s11701-020-01189-x

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