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OBJECTIVE: To review the role of robot-assisted endoscopic inguinal lymphadenectomy (RAIL) in the management of penile cancer. METHODS: A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword "robotic", "inguinal lymph node dissection", and "penile cancer". Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting factor. RESULTS: We identified 23 articles, of note the three largest series that included 102, 27, and 20 RAIL in 51, 14, and 10 patients, respectively. Saphenous vein was spared in 88.93% of RAIL cases in these series and node yield was 11.42 per groin; 35.28% of patients had positive pathological nodes. The weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per patient. The mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days; the major complication rate was only 5.31% in these series. The mean follow-up was 33.46 months with a recurrence-free survival of 96.33%. CONCLUSION: The literature regarding RAIL describes promising results, although it has shorter follow-up and higher costs when compared to historically series from the open approach. Initials series reported lower cutaneous complications compared to conventional approach, without compromising oncological outcomes. However, long-term results and larger trials are crucial to validate those findings.
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OBJECTIVE: The aim of this study was to report clinical features and management of penile cancer (CP) at the National Cancer Institute (INCan) of Mexico City over 20 years. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 405 cases of primary penile cancer (PC) treated at our institution between 1989 until 2015. Diagnosis, treatment and oncological outcomes are reported. RESULTS: Clinicopathologic and demographic information was available for 375 patients (mean age, 56 ys). At diagnosis, 140 (37.3 %) patients were cN0, 71(18.9%) cN1, 164 (43.37%) cN2 and 33 (8%) cN3. 14% had metastatic disease (lung and bone). Initial treatment included partial penectomy (n=123; 33.6%), and total penectomy (n=126;33.6%). 138 (36.2%) patients with high risk disease underwent bilateral inguinal lymph node dissection. 8% (56) had positive lymph nodes. Kaplan-Meier survival analysis showed a 10-year CSS (cancer specific survival) rate of 70%. There was no significant difference in CSS when stratifying per age. Five-year CSS for pT1, pT2, pT3 and T4 was 96%, 88%, 58% y T4 0%, respectively. A difference in CSS was found between pT2 and pT3 (p=0.047). CONCLUSION: The findings of our descriptive analysis provide information on natural history of penile cancer in Mexico. The surgical penile removal of the primary tumour remains standard of care. There was no difference in survival for age group.
OBJETIVO: Revisar las características clínicas y el manejo del cáncer de pene (CP) en el Instituto Nacional de Cancerología (INCan) de la Ciudad de México en 20 años de experiencia.MATERIAL Y MÉTODOS: Revisamos de forma retrospectiva a 405 pacientes con diagnóstico de CP tratados en INCan entre enero de 1989 hasta diciembre de 2015. Se describieron la modalidad de presentación de los casos, los resultados de patología, tratamiento y la sobrevida. RESULTADOS: Las informaciones clínico-patológicas y los resultados oncológicos fueron completas en 375 pacientes (edad media 56,82). Al diagnóstico 140 casos (n.37,3%) fueron cN0, 71 casos (18,9%) cN1, 164 casos (43,37%) cN2, 33 casos (8%) cN3. El 14% tuvieron metástasis a distancia (pulmón, huesos). El tratamiento inicial incluyó falectomía parcial (n=123; 33,6% y falectomía total (n=126; 33,6%). De 138 (36,2%) pacientes de alto riesgo sometidos a disección de ganglios linfáticos inguinales bilaterales, solo el 8% (n.56) tenían ganglios linfáticos positivos. El análisis de supervivencia de Kaplan-Meier mostró una tasa de SCE (sobrevida cáncer específica) a 10 años del 70%. No hubo diferencias significativas en la supervivencia para el grupo de edad. La CSS a 5 años para pT1, pT2, pT3 y T4 fue del 96%, 88%, 58% y 0%, respectivamente. Se encontró diferencia en la supervivencia entre pT2 y pT3 (p 0,047).CONCLUSIÓN: Los hallazgos de nuestra casuística proporcionan información sobre la historia natural del cáncer de pene en México. La amputación quirúrgica del tumor primario sigue siendo el patrón uro-oncológico para el tratamiento definitivo del CP. No hubo diferencias en la supervivencia para el grupo de edad.
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Neoplasias Penianas , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , México , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Penianas/diagnóstico , Neoplasias Penianas/patologia , Neoplasias Penianas/terapia , Estudos RetrospectivosRESUMO
Inguinal lymphadenectomy is the indicated procedure in the regional lymph node management for patients with lower limb melanoma and positive nodes. This procedure is commonly associated with surgical site complications. Video endoscopic inguinal lymphadenectomy is a minimally invasive alternative with oncological principles and lower wound-related morbidity. Incorporation of robotic surgery with optimal vision and great maneuverability would offer great advantages. A 42-year-old male patient was diagnosed with acral lentiginous melanoma and palpable inguinal nodes T2 N1 M0. The patient was scheduled for robot-assisted left inguinal video endoscopic lymphadenectomy. The working space is created using blunt-finger dissection and then extended with the endoscope by sweeping with the lens. Two 8-mm robotic trocars and a 10-mm trocar for assistant are placed. The lymphadenectomy is carried out with Maryland and scissors. The operative time was 130 min, estimated blood loss 70 ml and hospital stay 2 days. The robot-assisted inguinal video endoscopic lymphadenectomy is a safe and feasible procedure for lower limb melanoma treatment. The incorporation of the robotic system to this approach where there is a limited working space would offer advantages to the technique.
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Endoscopia/métodos , Sarda Melanótica de Hutchinson/cirurgia , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Cutâneas/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Humanos , Canal Inguinal , Perna (Membro) , Masculino , Duração da Cirurgia , Cirurgia Vídeoassistida/métodosRESUMO
OBJECTIVES: The objective was to submit our first experience in endoscopic inguinal lymphadenectomy (EIL), evaluate the feasibility of the procedure and carry out a review of the literature. MATERIAL AND METHODS: A 41-year-old patient was diagnosed with penile cancer with squamous cell carcinoma pT2G1 pathology, with no palpable inguinal lymph nodes. A bilateral inguinal lymphadenectomy was performed with preservation of the saphenous vein, conventional left and endoscopic right procedures. The perioperative data is presented and that obtained is discussed in the literature. RESULTS: The total time was 270 minutes, 180 for endoscopic and 90 for conventional procedures. Blood loss was minimal in both cases. Fifteen lymph nodes were dissected on the endoscopic side, and 17 in the conventional side, the latter with more pain and devitalised skin flap. CONCLUSIONS: EIL for penile cancer is feasible and there is less morbidity with an early recovery. The literature is not conclusive on the indication of EIL.
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PURPOSE: We reviewed our recent experience with inguinal lymph node dissection in patients with penile cancer to assess the incidence and magnitude of complications caused by this procedure. MATERIALS AND METHODS: Radical bilateral inguinal lymphadenectomy was performed in 170 patients (340 procedures). Prophylactic and therapeutic radical inguinal lymphadenectomy was done in 67 (39.4%) and 103 patients (60.6%), respectively. Operative time and length of hospital stay were examined. Complications were divided into minor and major, and early (30 days or less after surgery) and late (greater than 30 days), and analyzed. RESULTS: A total of 35 complications (10.3%) were observed, of which 25 (71.4%) were minor and 10 (28.6%) were major. We noted lymphedema in 14 patients (4.1%), seroma in 4 (1.2%), scrotal edema in 3 (0.9%), skin edge necrosis in 3 (0.9%), lymphocele in 3 (0.9%), wound infection in 2 (0.6%), flap necrosis in 2 (0.6%), wound abscess in 2 (0.6%) and deep venous thrombosis in 2 (0.6%). There was no significant difference in complication rates between patients treated with prophylactic vs therapeutic dissection. Mean hospital stay was 6.4 days (range 4 to 27). Average operative time for radical unilateral inguinal lymphadenectomy was 94 minutes. CONCLUSIONS: Our contemporary series includes a lower incidence of complications, such as wound infection, skin flap necrosis, lymphocele and lymphedema. To our knowledge this series represents the lowest incidence rate of complications described in the international literature.