Expanded criteria for video endoscopic inguinal lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes.
BACKGROUND
Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN.


METHODS
The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated).


RESULTS
The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 x 53,2 years, operative time 126,8 x 95,5 minutes, hospital stay 5. x 3.1 days, drainage time 6.7 x 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% x 26%, cellulitis 4.5% x 0%, lymphocele 23% in both groups, skin necrosis 0% x 3%, myocutaneous necrosis 4.5% x 0%, pN+ 33% x 32 %, cancer specific mortality 7 % x 5 % and mean follow-up 17.3 x 35.3 months. None of the variables presented p < 0.05.


CONCLUSIONS
VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN.
ABC Medical School, Santo André, SP, Brazil.
Alexandre Stievano
AS
Carlos
Pedro
P
Romanelli
Ricardo
R
Nishimoto
Luis M
LM
Montoya
César Augusto Braz
CA
Juliano
Renato Meirelles M da
RM
Costa
Antonio C L
AC
Pompeo
Marcos
M
Tobias-Machado
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010412:Penile Neoplasms / Q000601:surgery*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*