Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer
Marcos Tobias‐Machado, Antônio Augusto Ornellas, Alexandre Kyoshi Hidaka, Luis G. Medina, Pablo Aloisio Lima Mattos, Ruben S. Besio, Diego Abreu, Pedro Romanelli de Castro, Ricardo Hissashi Nishimoto, Juan Astigueta, Aurus Dourado, Roberto Dalledone Machado, Wesley Justino Magnabosco, Víctor Enrique Corona-Montes, Gustavo Villoldo, Hamilton C. Zampolli, Anis Taha, Pericles R. Auad, Eliney Ferreira Faria, Paulo B. O. Arantes, Alessandro Tavares, Francisco Sérgio Moura Silva do Nascimento, Éder Silveira Brazão, Maurìcio Murce Rocha, Walter Henriques da Costa, Vinicius Panico, Leonardo Oliveira Reis, Roberto J. Almeida-Carrera, R.C.M.A. da Silva, Stênio de Cássio Zéqui, José R. R. Calixto, René Sotelo
Abstract
OBJECTIVE: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.