ABC Medical School, Santo André, SP, Brazil.
Int Braz J Urol. 2013 Nov-Dec;39(6):893; discussion 894. doi: 10.1590/S1677-5538.IBJU.2013.06.17.
Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN.
The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated).
The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 x 53,2 years, operative time 126,8 x 95,5 minutes, hospital stay 5. x 3.1 days, drainage time 6.7 x 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% x 26%, cellulitis 4.5% x 0%, lymphocele 23% in both groups, skin necrosis 0% x 3%, myocutaneous necrosis 4.5% x 0%, pN+ 33% x 32 %, cancer specific mortality 7 % x 5 % and mean follow-up 17.3 x 35.3 months. None of the variables presented p < 0.05.
VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN.
开放性腹股沟淋巴结清扫术是治疗阴茎癌（PC）患者腹股沟转移的金标准。最近，视频内镜下腹股沟淋巴结清扫术（VEIL）被提出作为一种选择，以减少无可触及腹股沟淋巴结（PILN）患者手术的发病率，但在有 PILN 的患者中，其肿瘤学等效性仍研究甚少。本视频的目的是展示在有 PILN 的患者中进行 VEIL 的过程，并介绍比较有 PILN 和无 PILN 的患者的初步经验。
该视频展示了在 2 例先前因 PILN 行部分阴茎切除术的 PC 患者中进行的手术。将 15 例（22 条肢体手术）有 PILN 的患者的 VEIL 数据与我们的 25 例临床 N0 患者（35 条肢体手术）的 VEIL 系列进行比较。
在有 PILN 和无 PILN 的两组之间的比较中，分别发现了以下结果：年龄 52.45 x 53.2 岁，手术时间 126.8 x 95.5 分钟，住院时间 5. x 3.1 天，引流时间 6.7 x 5.7 天，平均每组切除 9 个淋巴结，总并发症 32% x 26%，蜂窝织炎 4.5% x 0%，两组均有淋巴囊肿 23%，皮肤坏死 0% x 3%，肌皮坏死 4.5% x 0%，pN+ 33% x 32%，癌症特异性死亡率 7% x 5%，平均随访 17.3 x 35.3 个月。没有一个变量有统计学意义（p < 0.05）。
VEIL 是治疗 PC 的一种安全的辅助治疗方法，即使在有 PILN 的患者中也是如此。有 PILN 的患者的肿瘤学结果似乎是合适的，但仍然非常不成熟。应该进行前瞻性多中心研究，以确定 VEIL 与开放性手术在有 PILN 的患者中的肿瘤学等效性，样本量更大，随访时间更长。
