Inguinal lymphadenectomy (IL) in penile cancer patients: comparison with laparoscopic (LIL) and open (OIL) techniques. Multicenter analysis with a median follow up of 5 years

==inizio objective==

Penile cancer (PC) is a rare malignant disease in Western countries: squamous cell carcinoma (SCC) of the penis accounts for >95% of cases of PC. Lymph node metastases occur in 20-40% of patients with SCC and are one of the strongest predictors of mortality: for these reasons, curative IL is recommended in any T1 grade 3-4 SCC and in all >T2 SCC. However, this procedure has been reported to lead to postoperative complications. The aim of our study is to compare differences of operative outcomes, post operative complications and survival outcomes between OIL and LIL cases in a multicenter series with a median follow up of 5 years.

==fine objective==

==inizio methodsresults==

A total of 55 patients with proven SCC underwent IL (according to EAU guidelines) in 3 centers, 26 LIL and 29 OIL 2were retrospectively analyzed. From September 2011 to January 2019 all patients were treated with bilateral IL open and laparoscopic approaches: we used preservation of the saphenous vein technique. In each center, an experiences laparoscopic surgeon performed all IL. We collected pre operative and operative data, complication rate, number of lymph nodes removed, survival outcomes. All data were compared during follow up period. Kaplan Meier curves were used to evaluate the survival outcomes.

==fine methodsresults==

==inizio results==

All LIL were completed successfully without conversion to OIL approach.
The median age was 60 (37-85) in OIL group and 59.3 (38-77) in LIL group.
For LIL and OIL groups, the mean operative time was 202 +/- 22 (180-250) and 148.4 +/- 32.1 (110-250) minutes, respectively. The numbers of superficial lymph nodes removed were similar the the both groups (12+/- 5 in the LIL and 12+/- 3.4 in the OIL), nevertheless, the deep lymph nodes were 3+/- 4.9 and 4+/- 2.6 in OIL versus LIL groups.
Hospital stays were lower in LIL group with mean 3.76 (3-10) as compared to OIL 8.4 (6-20).
As concerning the 30 days post-operative complications (POC), 4 (15%) patients in LIL group reported minimal wound complications. In OIL group, 8 (27.5%) patients had POC, 4 reported leg lymphedemas resolved in 2 months: 2 patients had deep venous thrombosis in >90 days complications.
In a median follow up period of 60 months, the overall survival was 65.5 and 84.6 in OIL and LIL groups respectively.

==fine results==

==inizio discussions==

The treatment for penile cancer in patients without evidence of lymphatic involvement is dictated by a risk–benefit analysis. At the moment, there is not enough evidence that allows for the standardization of the inguinal lymphadenctomy inn particular as concerning surgical technique.
Standard inguinal lymphadenectomy provides important information about the prognosis of the patient and it helps to remove early micrometastasis, nevertheless, the procedure has a high morbidity rate. Besides, other noninvasive methods such as the detection of metastasis with CT, MRI, high-resolution ultrasonography, and positron emission tomography/CT result in higher false-negative rates. the minimally invasive approach with laparoscopic technique as view in our study offers minor complications in comparison with open approach and the higher number of lymph nodes removed with best oncological outcomes.

==fine discussions==

==inizio conclusion==

The LIL is a safe procedure with better post-operative outcomes, minor complications rate and better survival in PC patients.

==fine conclusion==

==inizio reference==

1. Van Poppel, H., et al. Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2013. 24 Suppl 6: vi115.
2. Chaux, A., et al. Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma. World J Urol, 2013. 31: 861.
3. Verhoeven RH, Janssen-Heijnen ML, Saum KU et al. Population-based survival of penile cancer patients in Europe and the United States of America: no improvement since 1990. Eur J Cancer 2013;49:1414-21.
4. Stabile A, Muttin F, Zamboni S, et al. Therapeutic approaches for lymph node involvement in prostate, bladder and kidney cancer. Expert Rev Anticancer Ther. 2019;19(9):739-755-
5. Chipollini J, Azizi M, Lo Vullo S, et al. Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection. BJU Int. 2019;29.
6. EAU guidelines Penile cancer 2019

==fine reference==