Can Video Endoscopic Inguinal Lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients?

Background and Purpose: Radical lymphadenectomy improves survival in penile cancer patients, but the morbidity of the classic open procedure exceeds 50%. We report the updated results of Video Endoscopic Inguinal Lymphadenectomy (VEIL), an original minimally invasive procedure recently reported for extended inguinal node dissection in clinical settings. Patients and Methods: Fifteen consecutive patients who underwent the VEIL technique were prospectively followed and included in this study. The first 10 patients underwent bilateral inguinal dissection for nonpalpable lymph nodes: VEIL at one side and standard open lymph node dissection at the other side. A second cohort consisted of five patients who underwent bilateral VEIL, either for nonpalpable or for palpable (N1) inguinal nodes. Operative data and postoperative outcomes were assessed, and VEIL and the open technique were compared. Results: Twenty limbs underwent VEIL and 10 limbs underwent the open procedure. Mean operative time was 120 minutes for VEIL and 92 minutes for the open procedure. There was no difference in the number of nodes removed or in the positivity for metastatic lymph nodes. Complications were observed in 70% of limbs that underwent open surgery and in 20% of limbs that underwent VEIL (P = 0.015). Patients who underwent a bilateral VEIL could be discharged from the hospital after an average of 24 hours (range 12-36 hrs), while patients who underwent an open dissection in addition to contralateral VEIL were discharged after an average of 6.4 days (range 5-10 d) There were no recurrences detected during a mean follow-up of 31.9 months (median 33 months). Conclusion: This preliminary series suggests that VEIL can reduce morbidity, including hospitalization times, compared with standard open surgery. Oncologic results are premature but seem similar to the results from the conventional open operation. VEIL is a promising minimally invasive approach for radical inguinal dissection in penile cancer patients with nonpalpable or low-volume palpable inguinal disease.