TY - JOUR
T1 - Systematic Review and Meta-analysis of Minimally Invasive Procedures for Surgical Inguinal Nodal Staging in Penile Carcinoma
AU - Greco, Isabella
AU - Fernandez-Pello, Sergio
AU - Sakalis, Vasileios I.
AU - Barreto, Lenka
AU - Albersen, Maarten
AU - Ayres, Benjamin
AU - Antunes Lopes, Tiago
AU - Campi, Riccardo
AU - Crook, Juanita
AU - García Perdomo, Herney A.
AU - Johnstone, Peter A.S.
AU - Kailavasan, Mithun
AU - Manzie, Kenneth
AU - Marcus, Jack David
AU - Necchi, Andrea
AU - Oliveira, Pedro
AU - Osborne, John
AU - Pagliaro, Lance C.
AU - Parnham, Arie S.
AU - Pettaway, Curtis A.
AU - Protzel, Chris
AU - Rumble, R. Bryan
AU - Sachdeva, Ashwin
AU - Sanchez Martinez, Diego F.
AU - Zapala, Łukasz
AU - Tagawa, Scott T.
AU - Spiess, Philippe E.
AU - Brouwer, Oscar R.
N1 - Publisher Copyright:
© 2023
PY - 2023
Y1 - 2023
N2 - Context: There are several procedures for surgical nodal staging in clinically node-negative (cN0) penile carcinoma. Objective: To evaluate the diagnostic accuracy, perioperative outcomes, and complications of minimally invasive surgical procedures for nodal staging in penile carcinoma. Evidence acquisition: 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. Evidence synthesis: 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 < 0.01). Overall, VEIL/RA-VEIL had lower wound-related complication rates (OR 0.14; p < 0.01), including wound infections (OR 0.229; p < 0.01) and skin necrosis (OR 0.16; p < 0.01). The incidence of lymphatic complications varied between 20.6% and 49%. Conclusions: Of all the surgical staging options, DSNB with inguinal US + FNAC had the lowest complication rates and high diagnostic accuracy, especially when performed in high-volume centres. If DSNB is not available, favourable results were also found for VEIL/RA-VEIL over open ILND. Lymphatic-related complications were comparable across open and video-endoscopic ILND. Patient summary: We reviewed studies on different surgical approaches for assessing lymph node involvement in cases with penile cancer. The results show that a technique called dynamic sentinel node biopsy with ultrasound guidance and fine-needle sampling has high diagnostic accuracy and low complication rates. For lymph node dissection in penile cancer cases, a minimally invasive approach may offer favourable postoperative outcomes.
AB - Context: There are several procedures for surgical nodal staging in clinically node-negative (cN0) penile carcinoma. Objective: To evaluate the diagnostic accuracy, perioperative outcomes, and complications of minimally invasive surgical procedures for nodal staging in penile carcinoma. Evidence acquisition: 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. Evidence synthesis: 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 < 0.01). Overall, VEIL/RA-VEIL had lower wound-related complication rates (OR 0.14; p < 0.01), including wound infections (OR 0.229; p < 0.01) and skin necrosis (OR 0.16; p < 0.01). The incidence of lymphatic complications varied between 20.6% and 49%. Conclusions: Of all the surgical staging options, DSNB with inguinal US + FNAC had the lowest complication rates and high diagnostic accuracy, especially when performed in high-volume centres. If DSNB is not available, favourable results were also found for VEIL/RA-VEIL over open ILND. Lymphatic-related complications were comparable across open and video-endoscopic ILND. Patient summary: We reviewed studies on different surgical approaches for assessing lymph node involvement in cases with penile cancer. The results show that a technique called dynamic sentinel node biopsy with ultrasound guidance and fine-needle sampling has high diagnostic accuracy and low complication rates. For lymph node dissection in penile cancer cases, a minimally invasive approach may offer favourable postoperative outcomes.
KW - Meta-analysis
KW - Minimally invasive
KW - Nodal staging
KW - Penile cancer
KW - Surgical procedures
KW - Systematic review
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UR - http://www.scopus.com/inward/citedby.url?scp=85179673243&partnerID=8YFLogxK
U2 - 10.1016/j.euf.2023.11.010
DO - 10.1016/j.euf.2023.11.010
M3 - Review article
C2 - 38071107
AN - SCOPUS:85179673243
SN - 2405-4569
JO - European Urology Focus
JF - European Urology Focus
ER -