Robotic or open superficial inguinal lymph node dissection as staging procedures for clinically node negative high risk penile cancer

• Published in: Urologic oncology 2024-04, Vol.42 (4), p.120.e1-120.e9
• Main Authors: Ozambela, Manuel, McCormick, Barrett Z., Rudzinski, Jan K., Pieretti, Alberto C., González, Graciela M. Nogueras, Meissner, Matthew A., Papadopoulos, John N., Adibi, Mehrad, Matin, Surena F., Dahmen, Aaron S., Spiess, Philippe E., Pettaway, Curtis A.
• Format: Article
• Language: English
• Subjects: Clinically node negative; Inguinal lymph node dissection; Penile cancer; Penile squamous cell carcinoma; Robotic; Staging
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2024.01.036

•Robotic assisted inguinal lymph node dissection (RAIL) is an evolving operative strategy for the management of the inguinal region in patients with penile squamous cell carcinoma especially in the setting of clinically negative inguinal nodes (cN0).•In a cN0 setting, oncologic outcomes were similar between open superficial inguinal lymph node dissection (OSILND) and RAIL.•RAIL was associated with longer operative time, longer post-operative drain duration, and similar postoperative complication rates compared to OSILND.•Overall, RAIL is a reliable staging and potentially therapeutic procedure among cN0 patients with penile squamous cell carcinoma with comparable outcomes to an OSILND cohort. To evaluate perioperative and oncologic outcomes of a cohort of clinically node negative high-risk penile cancer patients undergoing robotic assisted inguinal lymph node dissection (RAIL) compared to patients undergoing open superficial inguinal lymph node dissection (OSILND). We retrospectively reviewed the clinical characteristics and outcomes of clinically node negative high-risk penile cancer patients undergoing RAIL at MDACC from 2013-2019. We sought to compare this to a contemporary open cohort of clinically node negative patients treated from 1999 to 2019 at MDACC and Moffit Cancer Center (MCC) with an OSILND. Descriptive statistics were used to characterize the study cohorts. Comparison analysis between operative variables was performed using Fisher's exact test and Wilcoxon's rank-sum test. The Kaplan-Meier method was used to estimate survival endpoints. There were 24 patients in the RAIL cohort, and 35 in the OSILND cohort. Among the surgical variables, operative time (348.5 minutes vs. 239.0 minutes, P < 0.01) and the duration of operative drain (37 vs. 22 days P = 0.017) were both significantly longer in the RAIL cohort. Complication incidences were similar for both cohorts (34.3% for OSILND vs. 33.3% for RAIL), with wound complications making up 33% of all complications for RAIL and 31% of complications for OSILND. No inguinal recurrences were noted in either cohort. The median follow-up was 40 months for RAIL and 33 months for OSILND. We observed similar complication rates and surgical variable outcomes in our analysis apart from operative time and operative drain duration. Oncological outcomes were similar between the two cohorts. RAIL was a reliable staging and potentially therapeutic procedure among clinically node negative patients with penile squamo