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

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Abstract

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.

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Data availability

Professor Asif Muneer had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Data are available for bona fide researchers who request it from the authors.

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Acknowledgements

Professor Asif Muneer is supported by the NIHR Biomedical Research Centre UCLH.

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Male Genital Cancer Centre, Department of Urology, University College London Hospitals NHS Trust, London, UK

    Nicolò Schifano, Giuseppe Fallara, Edoardo Pozzi, Fabio Castiglione, Matthew Rewhorn, Paul Hadway, Raj Nigam, Rowland Rees, Hussain Alnajjar & Asif Muneer

  2. Università Vita-Salute San Raffaele, Milan, Italy

    Giuseppe Fallara & Edoardo Pozzi

  3. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Giuseppe Fallara & Edoardo Pozzi

  4. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK

    Sean Rezvani, James Churchill, Vijay Sangar, Maurice Lau & Arie Parnham

  5. NIHR Biomedical Research Centre University College London Hospital, London, UK

    Asif Muneer

  6. Division of Surgery and Interventional Science, University College London, London, UK

    Asif Muneer

Authors
  1. Nicolò Schifano
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  2. Giuseppe Fallara
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  4. Edoardo Pozzi
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  5. James Churchill
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  6. Fabio Castiglione
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  7. Matthew Rewhorn
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  8. Paul Hadway
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  9. Raj Nigam
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  11. Vijay Sangar
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  12. Maurice Lau
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  15. Asif Muneer
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Contributions

NS: Data collection, Manuscript writing, Data analysis. GF: Data analysis, Manuscript editing. SR: Data collection. EP: Data collection. JC: Data collection. FC: Data collection. MR: Data collection, Manuscript writing. PH: Data collection, RN: Data collection, Manuscript editing. RR: Data collection, Manuscript editing. VS: Data collection, Manuscript editing. ML: Data collection, Manuscript editing. AP: Data collection, Manuscript editing, Project development. HMA: Data collection, Manuscript editing, Project development. AM: Data collection, Manuscript editing, Project development.

Corresponding author

Correspondence to Asif Muneer.

Ethics declarations

Conflict of interest

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflict of interest is to be declared.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The surgical procedures were in line with the institutional guidelines and operational policy and approved as part of the MDT process as part of standard management for penile cancer at our institutions.

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Informed consent was obtained from all individual participants included in the study.

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Schifano, N., Fallara, G., Rezvani, S. et al. Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique. World J Urol 41, 1581–1588 (2023). https://doi.org/10.1007/s00345-023-04396-x

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  • DOI: https://doi.org/10.1007/s00345-023-04396-x

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