Identification of superficial inguinal lymph nodes during low-risk penile cancer surgery using near-infrared (NIR) fluorescence to improve the accuracy of lymph-node dissection and reduce the incidence of missed micrometastases and complications.
Thirty-two cases were selected, which were under the criteria of < T1, and no lymph-node metastasis was found with magnetic resonance imaging (MRI) detection. Two groups were randomly divided based on the fluorescence technique, the indocyanine green (ICG) group and the non-ICG group. In the ICG group, the ICG preparation was subcutaneously injected into the edge of the penile tumor 10 min before surgery, and the near-infrared fluorescence imager was used for observation. After the lymph nodes were visualized, the superficial inguinal lymph nodes were removed first, and then, the penis surgery was performed. The non-ICG group underwent superficial inguinal lymph-node dissection and penile surgery.
Among the 16 patients in the ICG group, we obtained 11 lymph-node specimens using grayscale values of images (4.13 ± 0.72 vs. 3.00 ± 0.82 P = 0.003) along with shorter postoperative healing time (7.31 ± 1.08 vs. 8.88 ± 2.43 P = 0.025), and less lymphatic leakage (0 vs. 5 P = 0.04) than the 16 patients in the non-ICG group. Out of 11, 3 lymph nodes that are excised were further grouped into fluorescent and non-fluorescent regions (G1/G2) and found to be metastasized.
Near-infrared fluorescence-assisted superficial inguinal lymph-node dissection in penile carcinoma is accurate and effective, and could reduce surgical complications.
World journal of urology. 2024 Apr 01*** epublish ***
Xiaoting Yan, Chao Liu, Lijuan Cui, Pengyu Yan, Xiurong Fu, Weiyi Chen, Xiaofeng Yang
First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, People's Republic of China., Academy of Medical Sciences, Shanxi Medical University, Taiyuan, 030001, People's Republic of China., College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, People's Republic of China. ., First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001, People's Republic of China. .