Tobias-Machado Marcos, Tavares Alessandro, Ornellas Antônio Augusto, Molina Wilson Rica, Juliano Roberto Vaz, Wroclawski Eric Roger
Section of Urologic Oncology, Discipline of Urology, ABC Medical School, São Paulo and Albert Einstein Jewish Hospital Research Institute, National Institute of Cancer, Rio de Janeiro, Brazil.
J Urol. 2007 Mar;177(3):953-7; discussion 958. doi: 10.1016/j.juro.2006.10.075.
Video endoscopic inguinal lymphadenectomy is a recently described lymphadenectomy with the same template of the open technique but performed with laparoscopic instruments under video guidance. It was developed to decrease procedure related morbidity while maintaining good oncological results. We report our initial results in a trial comparing video endoscopic inguinal lymphadenectomy with standard inguinal lymphadenectomy.
From 2003 to 2005, 10 patients with penile carcinoma who were at high risk for inguinal metastases underwent bilateral inguinal lymphadenectomy. We performed standard lymphadenectomy in 1 limb and video endoscopic inguinal lymphadenectomy on the contralateral side. Perioperative results and followup data were compared.
No intraoperative complications occurred. Mean operative time was 92 and 126 minutes for open and endoscopic surgery, respectively (p=0.00002). Despite the small number of patients we noted a decrease in cutaneous complications with video endoscopic inguinal lymphadenectomy (0% vs 50%, p=0.017) and a trend toward decreased overall morbidity with this endoscopic technique (20% vs 70%, p=0.059). The mean number of retrieved and positive lymph nodes were similar for the 2 techniques. At a mean followup of 18.7 months (range 12 to 31) no signs of recurrence or disease progression were noted. In the postoperative period 9 of the 10 patients identified video endoscopic inguinal lymphadenectomy as the preferred technique in terms of surgical morbidity.
Video endoscopic inguinal lymphadenectomy is a safe and feasible technique in patients with penile carcinoma and nonpalpable nodes. These preliminary results suggest that video endoscopic inguinal lymphadenectomy may decrease postoperative morbidity without compromising oncological control. Future studies should include the bilateral procedure, longer term followup and a greater number of patients.
视频内镜下腹股沟淋巴结清扫术是一种最近描述的淋巴结清扫术，其手术模板与开放手术相同，但在视频引导下使用腹腔镜器械进行操作。该手术旨在降低与手术相关的发病率，同时保持良好的肿瘤学效果。我们报告了一项比较视频内镜下腹股沟淋巴结清扫术与标准腹股沟淋巴结清扫术的试验的初步结果。
2003年至2005年，10例有腹股沟转移高风险的阴茎癌患者接受了双侧腹股沟淋巴结清扫术。我们在一侧肢体进行标准淋巴结清扫术，在对侧进行视频内镜下腹股沟淋巴结清扫术。比较围手术期结果和随访数据。
术中无并发症发生。开放手术和内镜手术的平均手术时间分别为92分钟和126分钟（p = 0.00002）。尽管患者数量较少，但我们注意到视频内镜下腹股沟淋巴结清扫术的皮肤并发症有所减少（0%对50%，p = 0.017），并且这种内镜技术有降低总体发病率的趋势（20%对70%，p = 0.059）。两种技术回收的平均淋巴结数量和阳性淋巴结数量相似。平均随访18.7个月（范围12至31个月），未发现复发或疾病进展迹象。在术后期间，10例患者中有9例认为就手术发病率而言，视频内镜下腹股沟淋巴结清扫术是首选技术。
视频内镜下腹股沟淋巴结清扫术对于阴茎癌且无可触及淋巴结的患者是一种安全可行的技术。这些初步结果表明，视频内镜下腹股沟淋巴结清扫术可能降低术后发病率，而不影响肿瘤学控制。未来的研究应包括双侧手术、更长时间的随访和更多患者。
