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| Robot-assisted endoscopic inguinal lymphadenectomy: A review of current outcomes |
Gilberto José Rodriguesa,Giuliano Betoni Guglielmettia,Marcelo Orvietob,Kulthe Ramesh Seetharam Bhatc,Vipul R. Patelc,Rafael Ferreira Coelhoa,*( )
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a Sao Paulo State Cancer Institute, niversity of Sao Paulo School of Medicine, Sao Paulo, Brazil
b Clínica Alemana, Santiago, Chile
c Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States |
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Abstract Objective: To review the role of robot-assisted endoscopic inguinal lymphadenectomy (RAIL) in the management of penile cancer. Methods: A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword “robotic”, “inguinal lymph node dissection”, and “penile cancer”. Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting factor. Results: We identified 23 articles, of note the three largest series that included 102, 27, and 20 RAIL in 51, 14, and 10 patients, respectively. Saphenous vein was spared in 88.93% of RAIL cases in these series and node yield was 11.42 per groin; 35.28% of patients had positive pathological nodes. The weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per patient. The mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days; the major complication rate was only 5.31% in these series. The mean follow-up was 33.46 months with a recurrence-free survival of 96.33%. Conclusion: The literature regarding RAIL describes promising results, although it has shorter follow-up and higher costs when compared to historically series from the open approach. Initials series reported lower cutaneous complications compared to conventional approach, without compromising oncological outcomes. However, long-term results and larger trials are crucial to validate those findings.
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Received: 20 December 2019
Available online: 20 January 2021
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Corresponding Authors:
Rafael Ferreira Coelho
E-mail: coelhouro@yahoo.com.br
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| Characteristic | Singh et al., 2018 [31] | Russell et al., 2017 [30] | Matin et al., 2013 [29] | Weighted mean | | Number of patients | 51 | 14 | 10 | 38.63 | | Number of RAIL | 102 | 27 | 20 | 77.40 | | Age in yearsa | 58 (50-68) | 72 (62-76) | 62 (58-69) | 52.75 | | cTNM Stage, n (%) | | cN0 | 34 (67) | 14 (88)b | 20 (100) | 75.32 | | cN1 | 10 (20) | 2 (6)b | None | 14.72 | | cN2 | 7 (14) | 2 (6)b | None | 10.64 |
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Characteristics of patients from the three largest RAIL series, according to number of patients, procedures, age and clinical stage.
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| Characteristic | Singh et al., 2018 [31] | Russell et al., 2017 [30] | Matin et al., 2013 [29] | Weighted mean | | Depth of dissection of each RAIL, n (%) | | superficial only | 62 (61) | 16 (59) | 16 (80) | 63.19% | | superficial and deep | 40 (39) | 11 (41) | 4 (20)c | 36.81% | | Saphenous vein sparing, n (%) | 88 (86) | 27 (100) | Preserved when possible | 88.93% | | Node yield/groina | 13 (11-15) | 8 (6-12) | 8 (6-12) | 11.42 | | Superficial | NM | 8 (5-11) | 8 (6-13) | NA | | Deep | NM | 2 (1-2) | 2 (2-2) | NA | | Operative time per limba, min | 75 (70-85) | 137 (123-153) | (90-120)d | 87.98 | | Estimated blood lossa, mL | 75 (65-80) | 50 (15-50) | 100 (10-200)b | 37.08 | | Length of staya, day | 3 (3-4) | 1 (1-2)b | NM | 1.29 | | Duration of drainagea, day | 12 (10-15) | 36 (25-49) | NM | 17.02 |
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Operative outcomes from the three largest RAIL series, according to node dissection, saphenous vein sparing and perioperative findings.
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| Characteristic | Singh et al., 2018 [31] | Russell et al., 2017 [30] | Matin et al., 2013 [29] | Weighted mean | | Grade, n (%) | | 1 | 5 (9.8) | NM | NM | NA | | 2 | 39 (76.5) | NM | NM | NA | | 3 | 7 (13.7) | NM | NM | NA | | pT, n (%) | | pT1 | 14 (27.5) | NM | 3 (30) | NA | | pT2 | 26 (51.0) | NM | 4 (40) | NA | | pT3 | 11 (21.6) | NM | 3 (30) | NA | | pN+ | | Patients with pN+, n (%) | 20 (40) | 4 (29) | 2 (20) | 35.28% | | No. superficial nodesa | NM | 1 (1-2) | 2 (1-4) | NA | | No. deep nodesa | NM | 2 (1-2) | 1 (1-1) | NA | | Recurrence | | In-field recurrence, n (%) | None | 2 (11)b | NM | NA | | RFS, n (%) | 51 (100) | 15 (83)b | NM | 96.34% | | Follow-up, montha | 41 (28-57) | 6 (3-11) | NM | 33.46 |
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Oncological outcomes from the three largest RAIL series, according to pathological grade, tumoral and nodal staging and recurrence status.
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| Characteristic | Singh et al., 2018 [31] | Russell et al., 2017 [30] | Matin et al., 2013 [29] | Weighted mean | | Trans-operative issues per procedure, n (%) | None | None | 1 (5) | 0.67% | | Injury, no conversion | None | None | None | none | | Conversion, n (%) | None | None | 1 (5) | 0.67% | | Reason | None | None | Wrong plane with
visualization issues | NA | | Postoperative complications, patients, n (%) | 50 (98) | 3 (21) | 4 (40) | 75.89% | | Clavien-Dindo I and II | 49 (96), distributed in 35 Grade I
14 Grade II | 1 (7) lymphocele | 1 (10) cellulitis
1 (10) wound break-down
1 (10) skin necrosis | 66.99% | | Clavien-Dindo III and IV | 1 (2) flap necrosis patient, with episodes:
2 Grade 3a
1 Grade 3b | 1 (7) wound infection
1 (7) flap necrosis | 1 (10) cellulitis with abscess | 5.31% |
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Complications from the three largest RAIL series, according to trans-operative and postoperative period.
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