Video-endoscopic inguinal lymphadenectomy (VEIL) oncological and surgical benefits compared to open inguinal lymph node dissection (ILND)

Penile cancer accounts for about 1% of all male cancer diagnoses in the United States. Regional lymph node involvement is strongly correlated with overall outcomes, and as such the procedure of inguinal lymph node dissection (ILND) is imperative to the diagnostic and oncologic outcomes for these patients. The current gold standard of open ILND presents challenges in mitigating detrimental postoperative sequalae such as wound complications and lymphedema, without compromising oncologic outcomes. There has been a growing interest and shift in minimally invasive (MIS) approaches to tackle the challenges seen in the open approach to ILND. Several different minimally invasive techniques such as laparoscopic video-endoscopic inguinal lymphadenectomy (VEIL) and robotic-assisted VEIL approaches have been explored and described in the literature. A systematic literature search of PubMed and Medline (OVID) literature review was performed to assess outcomes in MIS approaches to ILND in comparison to traditional open approach. Key words included penile cancer/penile neoplasms, minimally-invasive procedures, robotics, video-endoscopic, robotic-assisted, inguinal lymphadenectomy, and inguinal lymph node dissections. Studies show that MIS approaches to ILND have potential to reduce high-grade postoperative complications, operative time, and hospital stay while ensuring oncologic outcomes. Despite the learning curve associated with MIS ILND, preliminary data does suggest favorable outcomes. Prospective, randomized trials are needed to reveal the full benefit of MIS ILND compared to open ILND.

Penile cancer; Minimally invasive; Video-endoscopic inguinal lymphadenectomy; Robotic; Inguinal lymphadenectomy

[1] American Cancer Society. Survival rates for penile cancer. Surveillance research program, national cancer institute. 2023. Available at: https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/survival-rates.html (Accessed: 27 December 2023).

[2] Elsamra SE, Poch MA. Robotic inguinal lymphadenectomy for penile cancer: the why, how, and what. Translational Andrology and Urology. 2017; 6: 826–832.

[3] Gómez-Ferrer A, Collado A, Ramírez M, Domínguez J, Casanova J, Mir C, et al. A single-center comparison of our initial experiences in treating penile and urethral cancer with video-endoscopic inguinal lymphadenectomy (VEIL) and later experiences in melanoma cases. Frontiers in Surgery. 2022; 9: 870857.

[4] O’Brien JS, McVey A, Kelly BD, Chee J, Lawrentschuk N. Recent developments in the diagnosis and management of N1 penile cancer. Current Opinion in Urology. 2023; 33: 64–69.

[5] Singh A, Jaipuria J, Goel A, Shah S, Bhardwaj R, Baidya S, et al. Comparing outcomes of robotic and open inguinal lymph node dissection in patients with carcinoma of the penis. Journal of Urology. 2018; 199: 1518–1525.

[6] Yang M, Liu Z, Tan Q, Hu X, Liu Y, Wei L, et al. Comparison of antegrade robotic assisted vs laparoscopic inguinal lymphadenectomy for penile cancer. BMC Surgery. 2023; 23: 55.

[7] Thyavihally YB, Dev P, Waigankar SS, Pednekar A, Kulkarni B, Sharma A, et al. Comparative study of perioperative and survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) and open inguinal lymph node dissection (O-ILND) in the management of inguinal lymph nodes in carcinoma of the penis. Journal of Robotic Surgery. 2021; 15: 905–914.

[8] Chua KJ, Balraj V, Patel HV, Srivastava A, Doppalapudi SK, Elsamra SE, et al. Wound complication rates after inguinal lymph node dissection: contemporary analysis of the NSQIP database. Journal of the American College of Surgeons. 2023; 236: 18–25.

[9] Chen J, Yan L, Luo G, Fang W, Liang C. Clinical application of noninflating video-endoscopic inguinal lymph node dissection. Computational and Mathematical Methods in Medicine. 2022; 2022: 8259990.

[10] Slaton JW, Morgenstern N, Levy DA, Santos MW Jr, Tamboli P, Ro JY, et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. Journal of Urology. 2001; 165: 1138–1142.

[11] National Comprehensive Cancer Network. Penile cancer. 2024. Available at: https://www.nccn.org/professionals/physician_gls/pdf/penile.pdf (Accessed: 09 May 2024).

[12] Bui T, Bordoni B. Anatomy, abdomen and pelvis: inguinal lymph node. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 8, 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557639 (Accessed: 09 May 2024)

[13] Rawal SK, Singh A, Khanna A. Robot-assisted video endoscopic inguinal lymph node dissection for carcinoma penis. Journal of Endourology. 2022; 36: S12–S17.

[14] Lam W, Alnajjar HM, La-Touche S, Perry M, Sharma D, Corbishley C, et al. Dynamic sentinel lymph node biopsy in patients with invasive squamous cell carcinoma of the penis: a prospective study of the long-term outcome of 500 inguinal basins assessed at a single institution. European Urology. 2013; 63: 657–663.

[15] Vreeburg MTA, Donswijk ML, Albersen M, Parnham A, Ayres B, Protzel C, et al. New EAU/ASCO guideline recommendations on sentinel node biopsy for penile cancer and remaining challenges from a nuclear medicine perspective. To be published in European Journal of Nuclear Medicine and Molecular Imaging. 2024. [Preprint].

[16] Catalona WJ. Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous veins: technique and preliminary results. Journal of Urology. 1988; 140: 306–310.

[17] Koifman L, Hampl D, Koifman N, Vides AJ, Ornellas AA. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes. Journal of Urology. 2013; 190: 2086–2092.

[18] Yao K, Tu H, Li Y, Qin Z, Liu Z, Zhou F, et al. Modified technique of radical inguinal lymphadenectomy for penile carcinoma: morbidity and outcome. Journal of Urology. 2010; 184: 546–552.

[19] Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World Journal of Urology. 2009; 27: 205–212.

[20] Tobias-Machado M, Ornellas AA, Hidaka AK, Medina LG, Mattos PAL, Besio RS, et al. Long-term oncological and surgical outcomes after video endoscopic inguinal lymphadenectomy (VEIL) in patients with penile cancer. International Brazilian Journal of Urology. 2023; 49: 580–589.

[21] Shao Y, Hu X, Ren S, Liao D, Yang Z, Liu Y, et al. Comparison of different surgical methods and strategies for inguinal lymph node dissection in patients with penile cancer. Scientific Reports. 2022; 12: 2560.

[22] Ji A, Lyu J, Bai Y, Jiang J, Liu F. Single-position robot-assisted versus laparoscopic antegrade bilateral inguinal lymphadenectomy for penile cancer: a retrospective controlled study. Asian Journal of Surgery. 2022; 45: 1530–1534.

[23] Patel KN, Salunke A, Bakshi G, Jayaprakash D, Pandya SJ. Robotic-assisted video-endoscopic inguinal lymphadenectomy (RAVEIL) and video-endoscopic inguinal lymphadenectomy (VEIL) versus open inguinal lymph-node dissection (OILND) in carcinoma of penis: comparison of perioperative outcomes, complications and oncological outcomes. a systematic review and meta-analysis. Urologic Oncology: Seminars and Original Investigations. 2022; 40: 112.e11–112.e22.

[24] Correa AF. Technical management of inguinal lymph-nodes in penile cancer: open versus minimal invasive. Translational Andrology and Urology. 2021; 10: 2264–2271.

[25] Ma Y, Hao J, Yin H, Zhu M, Guan B, Zhu C, et al. A laparoscopic radical inguinal lymphadenectomy approach partly preserving great saphenous vein branches can benefit for patients with penile carcinoma. BMC Surgery. 2022; 22: 138.

[26] Rodrigues GJ, Guglielmetti GB, Orvieto M, Seetharam Bhat KR, Patel VR, Coelho RF. Robot-assisted endoscopic inguinal lymphadenectomy: a review of current outcomes. Asian Journal of Urology. 2021; 8: 20–26.

[27] Russell CM, Salami SS, Niemann A, Weizer AZ, Tomlins SA, Morgan TM, et al. Minimally invasive inguinal lymphadenectomy in the management of penile carcinoma. Urology. 2017; 106: 113–118.

[28] Yu H, Lu Y, Xiao Y, Guo J, Yin X, Yang Y, et al. Robot-assisted laparoscopic antegrade versus open inguinal lymphadenectomy: a retrospective controlled study. BMC Urology. 2019; 19: 135.

[29] Nayak SP, Pokharkar H, Gurawalia J, Dev K, Chanduri S, Vijayakumar M. Efficacy and safety of lateral approach-video endoscopic inguinal lymphadenectomy (L-VEIL) over open inguinal block dissection: a retrospective study. Indian Journal of Surgical Oncology. 2019; 10: 555–562.

[30] Kumar V, Sethia KK. Prospective study comparing video-endoscopic radical inguinal lymph node dissection (VEILND) with open radical ILND (OILND) for penile cancer over an 8-year period. BJU International. 2017; 119: 530–534.

[31] Hu J, Li H, Cui Y, Liu P, Zhou X, Liu L, et al. Comparison of clinical feasibility and oncological outcomes between video endoscopic and open inguinal lymphadenectomy for penile cancer. Medicine. 2019; 98: e15862.

[32] Falcone M, Gül M, Peretti F, Preto M, Cirigliano L, Scavone M, et al. Inguinal lymphadenectomy for penile cancer: an interim report from a trial comparing open versus videoendoscopic surgery using a within-patient design. European Urology Open Science. 2024; 63: 31–37.

[33] Nabavizadeh R, Petrinec B, Nabavizadeh B, Singh A, Rawal S, Master V. Inguinal lymph node dissection in the era of minimally invasive surgical technology. Urologic Oncology. 2023; 41: 1–14.