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05.04.2023 | Original Article

Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique

verfasst von: Nicolò Schifano, Giuseppe Fallara, Sean Rezvani, Edoardo Pozzi, James Churchill, Fabio Castiglione, Matthew Rewhorn, Paul Hadway, Raj Nigam, Rowland Rees, Vijay Sangar, Maurice Lau, Arie Parnham, Hussain Alnajjar, Asif Muneer

Erschienen in: World Journal of Urology | Ausgabe 6/2023

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Abstract

Purpose

To describe our surgical technique and report the oncological outcomes and complication rates using a fascial-sparing radical inguinal lymphadenectomy (RILND) technique for penile cancer patients with cN+ disease in the inguinal lymph nodes.

Methods

Over a 10-year period, 660 fascial-sparing RILND procedures were performed in 421 patients across two specialist penile cancer centres. The technique used a subinguinal incision with an ellipse of skin excised over any palpable nodes. Identification and preservation of the Scarpa’s and Camper’s fascia was the first step. All superficial inguinal nodes were removed en bloc under this fascial layer with preservation of the subcutaneous veins and fascia lata. The saphenous vein was spared where possible. Patient characteristics, oncologic outcomes and perioperative morbidity were retrospectively collected and analysed. Kaplan–Meier curves estimated the cancer-specific survival (CSS) functions after the procedure.

Results

Median (interquartile range, IQR) follow-up was 28 (14–90) months. A median (IQR) number of 8.0 (6.5–10.5) nodes were removed per groin. A total of 153 postoperative complications (36.1%) occurred, including 50 conservatively managed wound infections (11.9%), 21 cases of deep wound dehiscence (5.0%), 104 cases of lymphoedema (24.7%), 3 cases of deep vein thrombosis (0.7%), 1 case of pulmonary embolism (0.2%), and 1 case of postoperative sepsis (0.2%). The 3-year CSS was 86% (95%Confidence Interval [95% CI] 77–96), 83% (95% CI 72–92), 58% (95% CI 51–66), respectively, for the pN1, pN2 and pN3 patients (p < 0.001), compared to a 3-year CSS of 87% (95% CI 84–95) for the pN0 patients.

Conclusion

Fascial-sparing RILND offers excellent oncological outcomes whilst decreasing the morbidity rates. Patients with more advanced nodal involvement had poorer survival rates, emphasizing the need for adjuvant chemo-radiotherapy.

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Titel: Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique
verfasst von: Nicolò Schifano
Giuseppe Fallara
Sean Rezvani
Edoardo Pozzi
James Churchill
Fabio Castiglione
Matthew Rewhorn
Paul Hadway
Raj Nigam
Rowland Rees
Vijay Sangar
Maurice Lau
Arie Parnham
Hussain Alnajjar
Asif Muneer
Publikationsdatum: 05.04.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 6/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04396-x

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Outcomes following radical inguinal lymphadenectomy for penile cancer using a fascial-sparing surgical technique