Brassetti Aldo, Pallares-Mendez Rigoberto, Bove Alfredo M, Misuraca Leonardo, Anceschi Umberto, Tuderti Gabriele, Mastroianni Riccardo, Licari Leslie C, Bologna Eugenio, Cartolano Silvia, D'Annunzio Simone, Ferriero Mariaconsiglia, Flammia Rocco S, Proietti Flavia, Leonardo Costantino, Simone Giuseppe
Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 43, 00143 Rome, Italy.
Cancers (Basel). 2024 Nov 22;16(23):3921. doi: 10.3390/cancers16233921.
Inguinal lymph node (LN) dissection (iLND) is mandatory in cN2 penile squamous cell carcinoma (PSCC). Open iLND (OIL) is often omitted due to the high rate of complications. A minimally invasive approach may reduce morbidity; however, evidence supporting its role to treat bulky nodes is limited. This study aimed to present the outcomes of the largest European single-center series of robot-assisted iLND (RAIL) for the treatment of cN2 PSCC and to compare the surgical and survival outcomes of this approach with the standard of care.
A retrospective analysis was conducted on men with cT1-4N2M0 PSCC undergone either OIL or RAIL at our institution from January 2014 onwards. Baseline demographics, perioperative data, and oncologic outcomes were analyzed.
Overall, 47 patients were included; 38 (81%) underwent OIL. Median age was 59 years, with 23 men (48%) presenting with a ≥4 Charlson comorbidity index. Operation time was significantly longer in the robotic cohort (212 min vs. 145 min; < 0.001), while the length of stay ( = 0.09) and time to inguinal drainage removal ( = 0.08) were not. Estimated blood loss favored the robotic approach (60 mL vs. 300 mL; < 0.001). Post-operative complications rates were comparable in the two groups (25% vs. 47%; = 0.17): four major complications were observed overall, and these were all in the OIL cohort. Median LN yield was comparable between the two groups (18 vs. 25; = 0.05). Final pathology reports showed no significant differences in tumor stage distribution between the cohorts ( = 0.54). Kaplan-Meier analysis did not reveal any significant differences in RFS probabilities between the two treatment groups (Log Rank = 0.99).
RAIL demonstrated comparable perioperative and oncologic outcomes to OIL for cN2 PSCC, with the benefit of reduced estimated blood loss. RAIL is a feasible option for cases where a minimally invasive approach is preferred, offering comparable perioperative safety and oncological outcomes.
对于cN2期阴茎鳞状细胞癌（PSCC），腹股沟淋巴结清扫术（iLND）是必要的。由于并发症发生率高，开放性iLND（OIL）常常被省略。微创方法可能会降低发病率；然而，支持其治疗肿大淋巴结作用的证据有限。本研究旨在呈现欧洲最大的单中心机器人辅助iLND（RAIL）系列治疗cN2期PSCC的结果，并将该方法的手术和生存结果与标准治疗进行比较。
对2014年1月起在我们机构接受OIL或RAIL治疗的cT1-4N2M0期PSCC男性患者进行回顾性分析。分析基线人口统计学、围手术期数据和肿瘤学结果。
总体而言，纳入了47例患者；38例（81%）接受了OIL。中位年龄为59岁，23名男性（48%）的Charlson合并症指数≥4。机器人手术组的手术时间明显更长（212分钟对145分钟；<0.001），而住院时间（=0.09）和腹股沟引流管拔除时间（=0.08）则没有差异。估计失血量有利于机器人手术方法（60毫升对300毫升；<0.001）。两组术后并发症发生率相当（25%对4
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