844 INGUINOFEMORAL LYMPHADENECTOMY: EVOLUTION OF A MODIFIED ENDOSCOPIC APPROACH TO MINIMIZE MORBIDITY
2010-03-23

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2010844 INGUINOFEMORAL LYMPHADENECTOMY: EVOLUTION OF A MODIFIED ENDOSCOPIC APPROACH TO MINIMIZE MORBIDITY Daniela Colleselli, David Schilling, Udo Nagele, Arnulf Stenzl, and Christian Schwentner Daniela ColleselliDaniela Colleselli , David SchillingDavid Schilling , Udo NageleUdo Nagele , Arnulf StenzlArnulf Stenzl , and Christian SchwentnerChristian Schwentner View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inguinofemoral lymphadenectomy is a standard procedure for penile cancer patients but is also indicated for other genitofemoral malignancies. Traditional open lymphadenectomy is associated with complication rates exceeding 50% with lymphatic edema and secondary wound healing being the most common. Herein, we present our experience with a modified endoscopic inguinofemoral lymphadenectomy (EL) in comparison with open surgery (OL). METHODS Both, patients with palpable and non non-palpable nodes were included in the study. OL consisted of classical superficial and deep inguinofemoral lymph node dissection. EL was done using a 3-trocar approach starting from the tip of the femoral triangle. Lymph node dissection was done with respect to the same boundaries as in open surgery. We apply a reduced CO2-pressure of only 5 mmHg to reduce skin emphysema and CO2 absorption. A suction drain was placed regardless of the technique. Operative data and postoperative outcomes were assessed, and EL and OL were statistically compared. RESULTS We performed 43 inguinofemoral lymph node dissections in a total of 32 patients (right n=24, left n=19). Of those 12 procedures were completed endoscopically. Overall follow-up was 35.2 months (3-63). Mean operative time for OL was 103.1 minutes (38-195) being significantly shorter than for EL (152.1 minute, 110-186), p<0.001. Both groups are comparable with respect to the number of nodes harvested (OL 7.2, 2-16 vs EL 6.8, 4-13) as well as to the number of affected nodes (OL 1,8 vs EL 1,6). Mean age and range were comparable in both cohorts (OL 58.8 years, 17-80 vs EL 63.1 years, 55-77), p=0.35. However, none of the classical complications (Lymphatic edema, secondary wound healing) of inguinofemoral lymphadenectomy occurred after EL leaving an overall complication rate of 8.3%. In contrast to that, complications appeared in more than half of the OL-cases (54,8%) with secondary wound healing being the most common (n=14) followed by lymphatic edema (n=13). There were no problems recorded due to CO2-insufflation. CONCLUSIONS Both OL and EL are reliable for inguinofemoral lymphadenectomy with regards to oncological efficacy. EL may be more technically challenging than OL reflected by a longer operative time. However, EL can avoid secondary wound healing and lymphatic stasis that are both extremely annoying complications. Moreover, EL is safe with a low complication rate. A reduction of the CO2-pressure further attributes to the favourable safety profile. Nevertheless, further prospective studies are required to confirm these data. Tuebingen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e329-e330 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniela Colleselli More articles by this author David Schilling More articles by this author Udo Nagele More articles by this author Arnulf Stenzl More articles by this author Christian Schwentner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...