1
|
Tobias-Machado M, Ornellas AA, Hidaka AK, Medina LG, Mattos PAL, Besio RS, Abreu D, Castro PR, Nishimoto RH, Astigueta J, Dourado A, Machado RD, Magnabosco WJ, Corona-Montes V, Villoldo GM, Zampolli HC, Taha A, Auad PR, Faria EF, Arantes PBO, Tavares A, Nascimento FSMS, Brazão ES, Rocha MM, Costa WH, Panico V, Reis LO, Almeida-Carrera RJ, Silva RC, Zequi SC, Calixto JRR, Sotelo R. Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer. Int Braz J Urol 2023; 49:580-589. [PMID: 37390124 PMCID: PMC10482462 DOI: 10.1590/s1677-5538.ibju.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
Collapse
Affiliation(s)
- Marcos Tobias-Machado
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | | | - Alexandre K Hidaka
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Luis G Medina
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pablo A L Mattos
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | - Juan Astigueta
- Universidad Privada Antenor Orrego, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo, Perú
| | - Aurus Dourado
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | | | - Anis Taha
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | - Pericles R Auad
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Walter H Costa
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Leonardo O Reis
- UroScience, Escola de Ciências Médicas, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de Campinas - PUC, Campinas, SP, Brasil
| | | | - Rafael C Silva
- Universidade Federal do Maranhão - UFMA, Maranhão, MA, Brasil
| | - Stênio C Zequi
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Rene Sotelo
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Bada M, Crocetto F, Nyirady P, Pagliarulo V, Rapisarda S, Aliberti A, Boccasile S, Ferro M, Barone B, Celia A. Inguinal lymphadenectomy in penile cancer patients: a comparison between open and video endoscopic approach in a multicenter setting. J Basic Clin Physiol Pharmacol 2023; 34:383-389. [PMID: 36933235 DOI: 10.1515/jbcpp-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To compare differences of operative outcomes, post-operative complications and survival outcomes between open and laparoscopic cases in a multicenter study. METHODS This was a retrospective cohort study performed at three European centers from September 2011 to January 2019. The surgeon decision to perform open inguinal lymphadenectomy (OIL) or video endoscopic inguinal lymphadenectomy (VEIL) was done in each hospital after patient counselling. Inclusion criteria regarded a minimum follow-up of 9 months since the inguinal lymphadenectomy. RESULTS A total of 55 patients with proven squamous cell penile cancer underwent inguinal lymphadenectomy. 26 of them underwent OIL, while 29 patients underwent VEIL. For the OIL and VEIL groups, the mean operative time was 2.5 vs. 3.4 h (p=0.129), respectively. Hospital stays were lower in the VEIL group with 4 vs. 8 days in OIL patients (p=0.053) while number of days requiring drains to remain in situ was 3 vs. 6 days (p=0.024). The VEIL group reported a lower incidence of major complications compared to the OIL group (2 vs. 17%, p=0.0067) while minor complications were comparable in both groups. In a median follow-up period of 60 months, the overall survival was 65.5 and 84.6% in OIL and VEIL groups, respectively (p=0.105). CONCLUSIONS VEIL is comparable to OIL regarding safety, overall survival and post-operative outcomes.
Collapse
Affiliation(s)
- Maida Bada
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Vicenza, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology - Federico II University of Naples, Naples, Italy
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Budapest, Italy
| | - Vincenzo Pagliarulo
- Department of Urology, Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Sebastiano Rapisarda
- Department of Urology, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Veneto, Italy
| | - Antonio Aliberti
- Urology, ASL 3 Napoli Castellammare di Stabia, Castellammare di Stabia, Italy
| | - Stefano Boccasile
- Department of Urology, Cima Barcelona Hospital, Barcelona, Catalogna, Spain
| | - Matteo Ferro
- Istituto Europeo di Oncologia, Milano, Lombardia, Italy
| | - Biagio Barone
- Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Campania, Italy
| | - Antonio Celia
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Veneto, Italy
| |
Collapse
|
3
|
Nabavizadeh R, Petrinec B, Nabavizadeh B, Singh A, Rawal S, Master V. Inguinal lymph node dissection in the era of minimally invasive surgical technology. Urol Oncol 2023; 41:1-14. [PMID: 32855056 DOI: 10.1016/j.urolonc.2020.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/19/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) is an essential step in both treatment and staging of several malignancies including penile and vulvar cancers. Various open, video endoscopic, and robotic-assisted techniques have been utilized so far. In this review, we aim to describe available minimally invasive surgical approaches for ILND, and review their outcomes and complications. METHODS The PubMed, Wiley Online Library, and Science Direct databases were reviewed in February 2020 to find relevant studies published in English within 2000-2020. FINDINGS There are different minimally invasive platforms available to accomplish dissection of inguinal nodes without jeopardizing oncological results while minimizing postoperative complications. Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy are safe and achieve the same nodal yield, a surrogate metric for oncological adequacy. When compared to open technique, Video Endoscopic Inguinal Lymphadenectomy and Robotic Video Endoscopic Inguinal Lymphadenectomy may offer faster postoperative recovery and fewer postoperative complications including wound dehiscence, necrosis, and infection. The relatively high rate and severity of postoperative complications hinders utilization of recommended ILND for oncologic indications. Minimally invasive approaches, using laparoscopic or robotic-assisted platforms, show some promise in reducing the morbidity of this procedure while achieving adequate short and intermediate term oncological outcomes.
Collapse
Affiliation(s)
- Reza Nabavizadeh
- Emory University School of Medicine, Department of Urology, Atlanta, GA
| | | | - Behnam Nabavizadeh
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Amitabh Singh
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Uro-Oncology Division, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Viraj Master
- Emory University School of Medicine, Department of Urology, Atlanta, GA.
| |
Collapse
|
4
|
Sood A, Rudzinski JK, Spiess PE, Pettaway CA. The Acute Complications After Surgery for Penile Carcinoma and Strategies for Their Management: A Systematic Review of the Literature. Semin Oncol Nurs 2022; 38:151285. [PMID: 35597731 DOI: 10.1016/j.soncn.2022.151285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the contemporary rates of 30-day complications after surgery for penile cancer and to discuss the currently used preventative and therapeutic practices aimed at mitigation of these postoperative adverse events. DATA SOURCES A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed, and studies reporting on the contemporary rates, nature, or management of acute complications following primary penile surgery or inguinal lymph node dissection for penile cancer were abstracted. Medline (PubMed) and EMBASE libraries were used to retrieve the articles published between January 1984 and December 2021 (n = 170 articles). Ultimately, 38 articles were included. The primary outcome of interest was 30-day (acute) postoperative complications, stratified by those associated with treatment of the primary penile lesion and those with inguinal lymph node dissection. Risk of bias assessment was undertaken. Special attention was paid to studies reporting management strategies for these complications. CONCLUSION This comprehensive review revealed that the quality of existing studies reporting on complications is poor and the risk of bias is high. Within these studies, the rates of acute complications following primary penile surgery and inguinal lymph node dissection ranged between 0% and 29.4% and 6% and 90%, respectively. More than 50% of these complications were wound related. Over the past two decades, several studies have reported on improved surgical techniques and protocolized postsurgical care pathways. Although the newer techniques have been associated with improved outcomes, the absolute rates of complications have remained high even in the most contemporary series. Therefore, there is an urgent need for health care providers and stakeholders to reach consensus regarding preoperative workup and medical optimization goals, stage appropriate therapies, and postoperative care pathways, as has been done for other malignancies associated with high morbidity. IMPLICATIONS FOR NURSING PRACTICE Penile cancer is a disease of the elderly, and surgical management of the primary lesion or the groins is associated with a high rate of complications. Most complications are wound related. Meticulous surgical technique and careful postoperative monitoring with early intervention are keys to mitigating surgery-related morbidity. However, equally important is dissemination and adoption of these principles by all health care workers universally.
Collapse
Affiliation(s)
- Akshay Sood
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jan K Rudzinski
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Curtis A Pettaway
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX.
| |
Collapse
|
5
|
Kandasamy SG, Chandran KR, Pooleri GK. Minimal invasive approaches in lymph node management of carcinoma of penis: A review. Indian J Urol 2022; 38:15-21. [PMID: 35136290 PMCID: PMC8796758 DOI: 10.4103/iju.iju_387_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Inguinal lymph node dissection (ILND) is an integral part in the management of carcinoma penis. The concerns about the postoperative morbidity associated with open ILND led to modification in the template of dissection and adoption of minimally invasive techniques such as video endoscopic inguinal lymphadenectomy (VEIL) and robotic-assisted VEIL (R-VEIL). In this review, we aim to describe the techniques, case selection, perioperative outcomes, and oncological outcomes of VEIL and R-VEIL and to compare it with open ILND. METHODS Databases of PubMed, Embase, and Google Scholar were searched to identify the articles for VEIL and R-VEIL. Using PRISMA guidelines, literature search yielded 3783 articles, of which 32 full-text articles relevant to the topic were selected and reviewed, after consensus from authors. RESULTS After the first description of VEIL, various modifications in port placements and approaches were described. Several studies have shown, VEIL and R VEIL are safe and feasible in both node-negative and node-positive Ca penis patients. Compared to open ILND, VEIL had fewer wound infections and skin necrosis, minimal blood loss, shorter mean hospital stays, and reduced duration of drain kept. There is no difference in mean lymph node yield and recurrence rates between open ILND, VEIL, R-VEIL. CONCLUSION VEIL and R-VEIL are safe and have comparable oncological outcomes with open ILND.
Collapse
Affiliation(s)
| | - Kosur Ravi Chandran
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ginil Kumar Pooleri
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India,E-mail:
| |
Collapse
|
6
|
Garcia L, Reis LO, García-Perdomo HA. Living in a rural area as a risk factor for worst outcomes in penile cancer. Int Braz J Urol 2021; 47:1259-1263. [PMID: 34115455 PMCID: PMC8486456 DOI: 10.1590/s1677-5538.ibju.2021.99.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lina Garcia
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Leonardo O Reis
- UroScience, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,Departamento de Urologia, Pontifícia Universidade Católica de Campinas - PUC - Campinas, Campinas, SP, Brasil
| | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia.,Division of Urology/Urooncology. Department of Surgery. School of Medicine. Universidad del Valle. Cali, Colombia
| |
Collapse
|
7
|
Favorito LA. Editorial Comment: External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes. Int Braz J Urol 2019; 45:679-680. [PMID: 31397988 PMCID: PMC6837600 DOI: 10.1590/s1677-5538.ibju.2018.0756.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A. Favorito
- Univ. Est. do Rio de Janeiro, Brasil; Hospital da Lagoa Federal, Brasil; International Braz J Urol, Brasil
| |
Collapse
|