Falcone Marco, Gül Murat, Peretti Federica, Preto Mirko, Cirigliano Lorenzo, Scavone Martina, Sedigh Omid, Oderda Marco, Gontero Paolo
Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
Neurourology Clinic, Unità Spinale Unipolare, A.O.U. Città della Salute e della Scienza, Turin, Italy.
Eur Urol Open Sci. 2024 Mar 21;63:31-37. doi: 10.1016/j.euros.2024.02.007. eCollection 2024 May.
Nodal metastasis is a major survival and prognostic factor in penile cancer (PeCa). Thus, accurate staging, prognosis, and treatment selection require adequate inguinal lymphadenectomy (ILND). ILND surgery should balance oncologic rigor with morbidity and postoperative complications. Our aim was to compare the feasibility and safety of open ILND (OILND) and videoendoscopic ILND (VEILND) in patients with PeCa.
We conducted a single-center randomized trial with a within-patient design between October 2019 and April 2023. Patients who were undergoing either staging or radical ILND for PeCa were included and randomized to receive either OILND or VEILND on one side, with the other technique then used on the contralateral side. The trial was approved by the local ethics committee and was registered on ClinicalTrials.gov (NCT05887921). The primary outcome was the safety of VEILND. Secondary outcomes included intraoperative and postoperative morbidity rates and surgical outcomes for the two procedures, as well as oncological outcomes according to survival estimates.
We included 14 patients in the study. Median follow-up was 12 mo (interquartile range [IQR] 12-17). There were no significant differences in operative time and the number of lymph nodes removed between OILND and VEILND. However, the median time to drain removal was significantly shorter in the VEILND group (15 d, IQR 13-17, 95% confidence interval [CI] 12-17) than in the OILND group (27 d, IQR 20-41, 95% CI 24-31; = 0.025). No intraoperative complications were observed, but postoperative complications occurred in three cases (21.4%, 95% CI 8.4-37.8%) in the VEILND group and eight (57.1%, 95% CI 18.6-54.3%) in the OILND group ( = 0.032).
VEILND represents a safe technique to consider for either staging or curative intent in PeCa and seems to have an advantage over OILND in terms of morbidity. Further high-powered studies are warranted to confirm these preliminary results.
We compared the outcomes of two different surgical techniques to remove lymph nodes in patients with penile cancer. We found that a video-assisted keyhole surgery approach seems to result in a lower rate of complications than after open surgery.
淋巴结转移是阴茎癌（PeCa）的主要生存和预后因素。因此，准确分期、判断预后以及选择治疗方案需要进行充分的腹股沟淋巴结清扫术（ILND）。ILND手术应在肿瘤根治性与发病率及术后并发症之间取得平衡。我们的目的是比较开放性ILND（OILND）和视频内镜下ILND（VEILND）在PeCa患者中的可行性和安全性。
我们于2019年10月至2023年4月进行了一项单中心、患者自身对照的随机试验。纳入接受PeCa分期或根治性ILND的患者，并随机分配在一侧接受OILND或VEILND，另一侧采用另一种技术。该试验经当地伦理委员会批准，并在ClinicalTrials.gov（NCT05887921）上注册。主要结局是VEILND的安全性。次要结局包括两种手术的术中及术后发病率、手术结果，以及根据生存估计得出的肿瘤学结果。
我们纳入了14例患者进行研究。中位随访时间为12个月（四分位间距[IQR]为12 - 17）。OILND和VEILND在手术时间和切除淋巴结数量方面无显著差异。然而，VEILND组引流管拔除的中位时间（15天，IQR 13 - 17，95%置信区间[CI] 12 - 17）明显短于OILND组（27天，IQR 20 - 41，95% CI 24 - 31；P = 0.025）。未观察到术中并发症，但VEILND组有3例（21.4%，95% CI 8.4 - 37.8%）发生术后并发症，OILND组有8例（57.1%，95% CI 18.6 - 54.3%）（P = 0.032）。
VEILND是一种可考虑用于PeCa分期或根治性手术的安全技术，在发病率方面似乎优于OILND。需要进一步开展大规模研究以证实这些初步结果。
我们比较了两种不同手术技术切除阴茎癌患者淋巴结的结果。我们发现，视频辅助小孔手术方法导致的并发症发生率似乎低于开放手术后的发生率。
