Systematic Review and Meta-analysis of Minimally Invasive Procedures for Surgical Inguinal Nodal Staging in Penile Carcinoma

• Published in: European urology focus 2024-07, Vol.10 (4), p.567-580
• Main Authors: Greco, Isabella, Fernandez-Pello, Sergio, Sakalis, Vasileios I., Barreto, Lenka, Albersen, Maarten, Ayres, Benjamin, Antunes Lopes, Tiago, Campi, Riccardo, Crook, Juanita, García Perdomo, Herney A., Johnstone, Peter A.S., Kailavasan, Mithun, Manzie, Kenneth, Marcus, Jack David, Necchi, Andrea, Oliveira, Pedro, Osborne, John, Pagliaro, Lance C., Parnham, Arie S., Pettaway, Curtis A., Protzel, Chris, Rumble, R. Bryan, Sachdeva, Ashwin, Sanchez Martinez, Diego F., Zapala, Łukasz, Tagawa, Scott T., Spiess, Philippe E., Brouwer, Oscar R.
• Format: Article
• Language: English
• Subjects: Biopsy, Fine-Needle - methods; Humans; Inguinal Canal; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Meta-analysis; Minimally invasive; Minimally Invasive Surgical Procedures - methods; Neoplasm Staging - methods; Nodal staging; Penile cancer; Penile Neoplasms - pathology; Penile Neoplasms - surgery; Postoperative Complications - epidemiology; Robotic Surgical Procedures - methods; Sentinel Lymph Node Biopsy - methods; Surgical procedures; Systematic review; Video-Assisted Surgery - methods
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2023.11.010

For patients with cN0 penile cancer, dynamic sentinel-node biopsy with preoperative inguinal ultrasound and fine-needle aspiration cytology has the lowest complication rates and high diagnostic accuracy. In comparison to open inguinal lymph node dissection (ILND), video-endoscopic ILND (with or without robot assistance) shows favourable results. Lymphatic-related complications are comparable between the open and video-endoscopic approaches. There are several procedures for surgical nodal staging in clinically node-negative (cN0) penile carcinoma. To evaluate the diagnostic accuracy, perioperative outcomes, and complications of minimally invasive surgical procedures for nodal staging in penile carcinoma. A systematic review of the Medline, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov was conducted. Published and ongoing studies reporting on the management of cN0 penile cancer were included without any design restriction. Outcomes included the false negative (FN) rate, the number of nodes removed, surgical time, and postoperative complications. Forty-one studies were eligible for inclusion. Four studies comparing robot-assisted (RA-VEIL) and video-endoscopic inguinal lymphadenectomy (VEIL) to open inguinal lymph node dissection (ILND) were suitable for meta-analysis. A descriptive synthesis was performed for single-arm studies on modified open ILND, dynamic sentinel node biopsy (DSNB) with and without preoperative inguinal ultrasound (US), and fine-needle aspiration cytology (FNAC). DSNB with US + FNAC had lower FN rates (3.5–22% vs 0–42.9%) and complication rates (Clavien Dindo grade I–II: 1.1–20% vs 2.9-11.9%; grade III–V: 0–6.8% vs 0–9.4%) in comparison to DSNB alone. Favourable results were observed for VEIL/RA-VEIL over open ILND in terms of major complications (2–10.6% vs 6.9–40.6%; odds ratio [OR] 0.18; p