There are several procedures for surgical nodal staging in clinically node-negative (cN0) penile carcinoma.
To evaluate the diagnostic accuracy, perioperative outcomes, and complications of minimally invasive surgical procedures for nodal staging in penile carcinoma.
A systematic review of the Medline, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov was conducted. Published and ongoing studies reporting on the management of cN0 penile cancer were included without any design restriction. Outcomes included the false negative (FN) rate, the number of nodes removed, surgical time, and postoperative complications.
Forty-one studies were eligible for inclusion. Four studies comparing robot-assisted (RA-VEIL) and video-endoscopic inguinal lymphadenectomy (VEIL) to open inguinal lymph node dissection (ILND) were suitable for meta-analysis. A descriptive synthesis was performed for single-arm studies on modified open ILND, dynamic sentinel node biopsy (DSNB) with and without preoperative inguinal ultrasound (US), and fine-needle aspiration cytology (FNAC). DSNB with US + FNAC had lower FN rates (3.5-22% vs 0-42.9%) and complication rates (Clavien Dindo grade I-II: 1.1-20% vs 2.9-11.9%; grade III-V: 0-6.8% vs 0-9.4%) in comparison to DSNB alone. Favourable results were observed for VEIL/RA-VEIL over open ILND in terms of major complications (2-10.6% vs 6.9-40.6%; odds ratio [OR] 0.18; p < 0.01). Overall, VEIL/RA-VEIL had lower wound-related complication rates (OR 0.14; p < 0.01), including wound infections (OR 0.229; p < 0.01) and skin necrosis (OR 0.16; p < 0.01). The incidence of lymphatic complications varied between 20.6% and 49%.
Of all the surgical staging options, DSNB with inguinal US + FNAC had the lowest complication rates and high diagnostic accuracy, especially when performed in high-volume centres. If DSNB is not available, favourable results were also found for VEIL/RA-VEIL over open ILND. Lymphatic-related complications were comparable across open and video-endoscopic ILND.
We reviewed studies on different surgical approaches for assessing lymph node involvement in cases with penile cancer. The results show that a technique called dynamic sentinel node biopsy with ultrasound guidance and fine-needle sampling has high diagnostic accuracy and low complication rates. For lymph node dissection in penile cancer cases, a minimally invasive approach may offer favourable postoperative outcomes.
European urology focus. 2023 Dec 08 [Epub ahead of print]
Isabella Greco, Sergio Fernandez-Pello, Vasileios I Sakalis, Lenka Barreto, Maarten Albersen, Benjamin Ayres, Tiago Antunes Lopes, Riccardo Campi, Juanita Crook, Herney A García Perdomo, Peter A S Johnstone, Mithun Kailavasan, Kenneth Manzie, Jack David Marcus, Andrea Necchi, Pedro Oliveira, John Osborne, Lance C Pagliaro, Arie S Parnham, Curtis A Pettaway, Chris Protzel, R Bryan Rumble, Ashwin Sachdeva, Diego F Sanchez Martinez, Łukasz Zapala, Scott T Tagawa, Philippe E Spiess, Oscar R Brouwer
Department of Urology, Hospital Universitario Rey Juan Carlos, Madrid, Spain. Electronic address: ., Department of Urology, Cabueñes University Hospital, Gijón, Spain., Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece., Department of Urology, University Hospital Nitra, Nitra, Slovakia., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, St. George's University Hospitals NHS Foundation Trust, London, UK., Department of Urology, Hospital de S. João, Porto, Portugal., Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, Florence, Italy., British Columbia Cancer Agency, University of British Columbia, Kelowna, Canada., Division of Urology/Uro-oncology, Department of Surgery, Universidad Del Valle, Cali, Colombia., Departments of Radiation Oncology and Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA., Nottingham City Hospital, Nottingham, UK., Patient representative, Orchid, London, UK., Patient advocate, Us TOO, New York, NY, USA., Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Pathology, The Christie NHS Foundation Trust, Manchester, UK., Department of Oncology, Mayo Clinic, Rochester, MN, USA., Department of Urology, The Christie NHS Foundation Trust, Manchester, UK., University of Texas MD Anderson Cancer Center, Houston, TX, USA., Helios Clinics Schwerin, Schwerin, Germany., American Society of Clinical Oncology, Alexandria, VA, USA., Division of Cancer Sciences, University of Manchester, Manchester, UK., School of Medical Sciences, Universidad Nacional de Asuncion, Asuncion, Paraguay., Department of Urology, Medical University of Warsaw, Warsaw, Poland., Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.