Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
Curr Opin Urol. 2019 Mar;29(2):165-172. doi: 10.1097/MOU.0000000000000588.
In penile cancer, lymphadenectomy can have staging and possibly therapeutic values. However, many physicians and patients are reluctant when it comes to inguinal lymph node dissection (ILND) due to high rate of surgical morbidities. In recent years, minimally invasive surgical approaches have shown success in reducing perioperative morbidities.
Newer surgical modalities, including videoscopic inguinal lymphadenectomy and robotic-assisted inguinal lymphadenectomy, have been explored to reduce the morbidities of ILND while not compromising oncologic outcomes. Data on this topic is limited but available data suggest that these minimally invasive techniques are safe and associated with less perioperative morbidities. There is no study to directly compare the oncological outcome between these different techniques. However, number of dissected lymph nodes is used a surrogate for oncologic outcomes. Different treatment approaches including open, laparoscopic, and robotic seem to be similar and effective in terms of nodal yield.
Laparoscopic and robotic approaches are successful in dissecting inguinal lymph nodes and are associated with lower rate of major perioperative complications. Individual patient's characteristics as well as surgeon's experience should be considered when trying to decide the optimum surgical modality for ILND.
在阴茎癌中，淋巴结清扫术具有分期和可能的治疗价值。然而，由于手术并发症发生率高，许多医生和患者都不愿意进行腹股沟淋巴结清扫术（ILND）。近年来，微创外科方法已成功地降低了围手术期的发病率。
包括腹腔镜腹股沟淋巴结清扫术和机器人辅助腹股沟淋巴结清扫术在内的新手术方式已被探索用于减少 ILND 的发病率，同时不影响肿瘤学结果。关于这个主题的数据有限，但现有数据表明，这些微创技术是安全的，并且与较少的围手术期发病率相关。目前尚无研究直接比较这些不同技术的肿瘤学结果。然而，淋巴结清扫的数量被用作肿瘤学结果的替代指标。不同的治疗方法，包括开放、腹腔镜和机器人，在淋巴结切除方面似乎相似且有效。
腹腔镜和机器人方法在解剖腹股沟淋巴结方面是成功的，并且与较低的主要围手术期并发症发生率相关。在尝试决定 ILND 的最佳手术方式时，应考虑患者的个体特征和外科医生的经验。
