Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

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.

Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes

“…The objective of ILND for individuals with PeCa is to obtain precise local staging, provide guidance for adjuvant treatment choices, and enhance overall survival rates. ILND is the gold-standard treatment for inguinal node-positive patients, and its staging role has been refined in cN0 disease after the introduction of DSNB [1,9,12]. Nevertheless, ILND continues to play a role in this setting since false negative cases after a DSNB are still an issue while its availability is scarce [4].…”

“…Although OILND has been demonstrated to be an effective procedure, the significant associated morbidity has been a considerable burden for both surgeons and patients. In this regard, the minimally invasive approach as laparoscopic (VEIL) or robotic (RA-VEIL) has been proven to reduce postoperative morbidity while maintaining the oncological efficacy [7][8][9]. Furthermore, a simultaneous approach has been proposed for both staging and treatment purposes in patients elected for bilateral invasive inguinal node assessment to further decrease surgery-related complications.…”

“…However, both templates have been associated with a high morbidity burden and long sequelae [1,5]. Since it was first described in 2006, minimally invasive video-endoscopic inguinal lymphadenectomy (VEIL) has led to significant advantages as compared to the open approach by reducing postoperative morbidity while maintaining comparable oncological outcomes [6][7][8][9]. Furthermore, several other refinements have been attempted to improve surgical outcomes through the introduction of a robotic approach [10][11][12].…”

International Brazilian Journal of Urology is among the Top 10 urologic journals - the new Impact Factor is 3.7!

“…Dr. Tobias-Machado and collegues from Brazil performed in page 580 ( 3 ) a nice study about the long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer and concluded that 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.…”