Minimally invasive techniques to reduce complications of inguinal lymphadenectomy

摘要

Abstract: Appropriate management of lymph nodes is critical in patients with malignancy of the inguinal region, particularly penile cancer which has a propensity for regional dissemination from inguinal to pelvic lymph nodes then distant spread. Lymphadenectomy is the gold standard for staging and treatment of locally advanced penile cancer. This procedure has conventionally been performed in an open fashion and is associated with significant morbidity and complication rates. Many physicians and patients are reluctant to perform inguinal lymph node dissection (ILND) due to such high rates of morbidities. Minimally invasive technologies such as video endoscopic inguinal lymphadenectomy (VEIL) and robot-assisted VEIL have emerged as feasible alternatives that reduce complications (i.e., skin necrosis, wound infections, blood loss) while maintaining oncological outcomes similar to those of open ILND. Current studies show that these modalities are safe and feasible in both node-negative and node-positive penile cancer patients. Template modifications have also been developed to minimize complications. These innovations in ILND can subsequently allow patients to better tolerate the procedure, and surgeons can offer surgery to those who would otherwise not be candidates or willing to have surgery. Our aim is to highlight the minimally invasive methods to reduce complications for inguinal lymphadenectomy in penile cancer and review their perioperative morbidity and oncological equivalency.