Comparing the Perioperative and Oncological Outcomes of Open Versus Minimally Invasive Inguinal Lymphadenectomy in Penile Cancer: A Systematic Review and Meta-Analysis.
Yu Guang Tan, Khi Yung Fong, Nathanael Kai-Jun Goh, Alvin Ym Lee, Kae Jack Tay, John Sp Yuen, Michael R Abern, Kenneth Chen
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引用次数: 0
Abstract
Background: Long-term survival in penile cancer is dependent on the presence and extent of lymph node metastases. Historically, inguinal lymph node dissection (ILND) has been performed via an open approach (O-ILND). More recently, minimally invasive surgical alternatives (MIS-ILND) such as video-endoscopic and robot-assisted ILND have emerged. This review aims to compare the (1) perioperative outcomes, (2) complication rates, and (3) oncological efficacy between O-ILND and MIS-ILND.
Methods: We conducted a PRISMA-compliant meta-analysis including studies comparing O-ILND versus MIS-ILND for penile cancer. Outcomes were pooled in random-effects meta-analyses.
Results: Sixteen articles comprising 1054 patients were analysed. There was an observed trend towards longer operative time for the MIS-ILND approach (mean difference 28 min; 95% CI -2 to 58 min, p = 0.06), particularly with the robotic-assisted technique. Total LN yield (mean 12.3, mean difference 0.3, 95% CI -0.3 to 0.9, p = 0.13), and positive LN (RR 0.98, 95% CI 0.88-1.10, p = 0.75) were similar between groups. MIS-ILND significantly reduced complication rates for both minor (RR: 0.65, 95% CI 0.45-0.94, p = 0.02) and major complications (RR: 0.25, 95% CI 0.12-0.53, p = 0.002). Particularly, there was also lower wound infection rate with MIS-ILND (RR: 0.43, 95% CI 0.22-0.82, p = 0.02), corresponding to a shorter hospital stay of average 4 days (MD -4, 95% CI -6--2, p = 0.05). Rates of skin/flap necrosis, lymphedema, lymphocele, and drainage time did not differ significantly. Local groin recurrence and overall survival did not differ between approaches.
Conclusions: MIS-ILND is associated with fewer perioperative complications and shorter hospitalisation without compromising oncologic outcomes. These findings support its broader adoption, particularly in high-volume centres with appropriate surgical expertise.
背景：阴茎癌的长期生存取决于淋巴结转移的存在和程度。历史上，腹股沟淋巴结清扫（ILND）是通过开放入路（O-ILND）进行的。最近，微创手术替代方案（MIS-ILND），如视频内窥镜和机器人辅助的ILND已经出现。本综述旨在比较(1)O-ILND与MIS-ILND的围手术期预后，(2)并发症发生率，以及(3)肿瘤疗效。方法：我们进行了一项符合prisma标准的荟萃分析，包括比较O-ILND与misi - ilnd治疗阴茎癌的研究。结果在随机效应荟萃分析中汇总。结果：共分析16篇1054例患者。观察到，MIS-ILND入路的手术时间有延长的趋势（平均差28分钟；95% CI -2至58分钟，p = 0.06），特别是机器人辅助技术。总LN产率（平均12.3，平均差0.3,95% CI -0.3 ~ 0.9, p = 0.13）和阳性LN （RR 0.98, 95% CI 0.88 ~ 1.10, p = 0.75）组间相似。MIS-ILND显著降低了轻微并发症（RR: 0.65, 95% CI 0.45-0.94, p = 0.02）和严重并发症（RR: 0.25, 95% CI 0.12-0.53, p = 0.002）的并发症发生率。特别是，misi - ilnd的伤口感染率也较低（RR: 0.43, 95% CI 0.22-0.82, p = 0.02），平均住院时间缩短为4天（MD -4, 95% CI -6- 2, p = 0.05）。皮肤/皮瓣坏死、淋巴水肿、淋巴囊肿的发生率和引流时间无显著差异。不同入路的腹股沟局部复发率和总生存率无差异。结论：MIS-ILND与较少的围手术期并发症和较短的住院时间相关，且不影响肿瘤预后。这些发现支持其更广泛的采用，特别是在具有适当外科专业知识的大容量中心。
期刊介绍：
Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.
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