Techniques, outcomes, and complications of minimally invasive inguinal lymphadenectomy in cancer of the penis: an international clinical review

摘要

Abstract: The overwhelming majority (95%) of penile cancers are of the squamous cell carcinoma (SCC) variety. SCC of the penis tends to metastasize through the lymphatic system to the inguinal lymph nodes, both superficial and deep, and then on to pelvic nodes. Video endoscopic inguinal lymphadenectomy (VEIL) is an emerging minimally invasive option for inguinal lymphadenectomy (MIIL). There are some technical variations reported as lateral approach VEIL (L-VEIL), VEIL with hypogastric proposition (H-VEIL) and robotic-assisted VEIL (R-VEIL). Our paper aimed to discuss the technical aspects, complications, and operative outcomes associated with VEIL. We looked over literature that was available online, conducted using terms including “Video Endoscopic Inguinal Dissection”, “VEIL”, “Robot-assisted Inguinal dissection”, “R-VEIL”, “RAVEIL”, and “Minimal invasive Inguinal dissection” in PubMed, Google Scholar, and Embase libraries. available on the surgical treatment of MIIL. It included the consolidated expertise of the authors in the technical that it will be presented as well as important historical articles and clinical guidelines relating to management of the VEIL. Limitations were placed on the search to include only articles that were relevant. We faced the indications, MIIL Step-by-Step procedure, the postoperative care, the drawbacks and data reported about oncological follow-up after surgery. The evaluation of the MIIL Step-by-Step procedure has achieved an important reduction in skin necrosis and wound infection, bleeding quantity, length of hospitalization, and period of drainage instead to open inguinal lymph node dissection (ILND) approach. Notably, it seems to be similar comparing VEIL, L-VEIL, H-VEIL and R-VEIL regarding morbidity, complications and oncological outcomes. Available evidence suggests that all MIIL are associated with more benefits in: reducing complications with analogous oncological outcomes with ILND; and the 5-year survival rates were comparable, with ILND at 65% and VEIL at 66.8% (P=0.636), although the follow-up period has been shorter.