Endoscopic inguinofemoral lymphadenectomy--extended follow-up.
OBJECTIVE
Inguinofemoral lymphadenectomy (IFLA) is a standard procedure for cancer of the external genitalia. Open lymphadenectomy (O-IFLA) exhibits complication rates of more than 50%. We are demonstrating our extended experience with a modified endoscopic approach (E-IFLA) for groin lymphadenectomy.


METHODS
Patients with nonpalpable as well as those with palpable nodes who had IFLA were identified. O-IFLA comprised both superficial and deep inguinal lymph node dissection. E-IFLA was performed using a three-trocar approach in the same field. We used a reduced CO2-pressure of <5 mm Hg. A suction drain was always placed. Perioperative data and postoperative outcomes were systematically assessed followed by statistical analysis.


RESULTS
We performed 62 IFLAs in 42 patients. Twenty-eight procedures were completed endoscopically. Follow-up was 55.8 months (2-87 mos). Mean operative time for O-IFLA was 101.7 minutes (38-195 min), being shorter than for E-IFLA (136.3 min, 87-186 min), P<0.001. Both groups are comparable regarding the number of nodes (O-IFLA 7.2, 2-16 vs E-IFLA 7.1, 4-13) as well as with regard to the number of positive nodes (O-IFLA 1.8 vs E-IFLA 1.6). Secondary wound healing and leg edema were extremely rare events (1/28) after E-IFLA. The overall complication rate was 7.1%. Complications appeared in 55.3% of the O-IFLA-cases. There were no problems related to CO2 insufflation. Local recurrence rates were identical in both groups.


CONCLUSIONS
O-IFLA and E-IFLA are efficient with respect to oncologic safety. E-IFLA is technically more challenging. E-IFLA can avoid secondary wound healing and lymphatic complications. E-IFLA is a safe procedure while a reduction of CO2 pressures optimizes the safety profile. Because cancer control rates remained equivalent during an extended follow-up, oncologic durability could be confirmed.
Department of Urology, Eberhard-Karls University, Tuebingen, Germany. christian.schwentner@med.uni-tuebingen.de
Christian
C
Schwentner
Tilman
T
Todenhöfer
Joerg
J
Seibold
Saladin H
SH
Alloussi
Johannes
J
Mischinger
Stefan
S
Aufderklamm
Arnulf
A
Stenzl
Georgios
G
Gakis
D059925:Anatomic Landmarks; D004210:Dissection; D004724:Endoscopy; D000071938:Fasciotomy; D005263:Femoral Artery / Q000473:pathology / Q000601:surgery; D005269:Femur / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D012501:Saphenous Vein / Q000473:pathology / Q000601:surgery; D016683:Supine Position; D013525:Surgical Instruments