This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Comparing Outcomes of Open and Robot-Assisted Inguinal Lymphadenectomy for the Treatment of cN2 Squamous Cell Carcinoma of the Penis: A Retrospective Single-Center Analysis
by
, , , , , , ,
Aldo Brassetti
,
Rigoberto Pallares-Mendez
*
,
Alfredo M. Bove
,
Leonardo Misuraca
,
Umberto Anceschi
, 
Gabriele Tuderti
,
Riccardo Mastroianni
,
Leslie C. Licari
,
Eugenio Bologna
,
Silvia Cartolano
,
Simone D’Annunzio
,
Mariaconsiglia Ferriero
,
Rocco S. Flammia
,
Flavia Proietti
,
Costantino Leonardo
and
Giuseppe Simone
Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 43, 00143 Rome, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(23), 3921; https://doi.org/10.3390/cancers16233921
Submission received: 7 October 2024
/
Revised: 17 November 2024
/
Accepted: 21 November 2024
/
Published: 22 November 2024
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
Simple Summary
This study assessed 47 patients with penile cancer who underwent inguinal lymphadenectomy using either an open or robot-assisted approach. Our observations showed that robot-assisted inguinal lymphadenectomy resulted in longer operating times and less bleeding compared to the open approach. No significant differences were observed between the two groups for other perioperative variables. After a five-year follow-up, there were no differences in recurrence-free survival or overall survival between the groups.
Abstract
Background: Inguinal lymph node (LN) dissection (iLND) is mandatory in cN2 penile squamous cell carcinoma (PSCC). Open iLND (OIL) is often omitted due to the high rate of complications. A minimally invasive approach may reduce morbidity; however, evidence supporting its role to treat bulky nodes is limited. This study aimed to present the outcomes of the largest European single-center series of robot-assisted iLND (RAIL) for the treatment of cN2 PSCC and to compare the surgical and survival outcomes of this approach with the standard of care. Methods: A retrospective analysis was conducted on men with cT1-4N2M0 PSCC undergone either OIL or RAIL at our institution from January 2014 onwards. Baseline demographics, perioperative data, and oncologic outcomes were analyzed. Results: Overall, 47 patients were included; 38 (81%) underwent OIL. Median age was 59 years, with 23 men (48%) presenting with a ≥4 Charlson comorbidity index. Operation time was significantly longer in the robotic cohort (212 min vs. 145 min; p < 0.001), while the length of stay (p = 0.09) and time to inguinal drainage removal (p = 0.08) were not. Estimated blood loss favored the robotic approach (60 mL vs. 300 mL; p < 0.001). Post-operative complications rates were comparable in the two groups (25% vs. 47%; p = 0.17): four major complications were observed overall, and these were all in the OIL cohort. Median LN yield was comparable between the two groups (18 vs. 25; p = 0.05). Final pathology reports showed no significant differences in tumor stage distribution between the cohorts (p = 0.54). Kaplan–Meier analysis did not reveal any significant differences in RFS probabilities between the two treatment groups (Log Rank = 0.99). Conclusions: RAIL demonstrated comparable perioperative and oncologic outcomes to OIL for cN2 PSCC, with the benefit of reduced estimated blood loss. RAIL is a feasible option for cases where a minimally invasive approach is preferred, offering comparable perioperative safety and oncological outcomes.
