| Objective To compare the clinical efficacy of video endoscopic inguinal lymphadenectomy via the limb approach(VEIL-L)and video endoscopic inguinal lymphadenectomy via the hypogastric subcutous approach(VEIL-H)in inguinal lymph node dissection for penile cancer was contrasted in order to provide scientific basis for clinical selection.Methods The clinical data of 27 patients with penile carcinoma who underwent VEIL were collected from Novemmber 2015 to December 2018 in the Department of Urology and Andrology,the Second Affiliated Hospital of Kunming Medical University.Among them,11 cases were treated with VEIL-H as VEIL-H group,and the other 16 cases were treated with VEIL-L as VEIL-L group.All patients of two groups were diagnosed as penile squamous cell carcinoma by pathological biopsy before the operation.The preoperative general clinical data,operative time,intraoperative blood loss,number of lymph nodes resected,postoperative hospital stay,indwelling time of drainage tube,rate of the complications and follow-up were compared between the two groups.The data were analyzed by the independent sample t test and the ?2 test in the statistical software SPSS 24.0.Results Twenty-seven patients with penile carcinoma were successfully completed inguinal lymph node dissection,and no case was converted to open surgery.There was no significant difference in preoperative general clinical data(age,BMI index,tumor size,tumor pathological stage and grade,preoperative lymph node status)between the two groups.VEIL-H group compared with VEIL-L group:there were significant differences between the operation time(137.36±20.22 min vs.163.00 ±35.30 min,t=-2.169,P=0.040)and intraoperative blood loss(77.73±13.85 ml vs.100.00±33.07 ml,t=-2.101,P 0.046).There were no significant differences among the average number of lymph nodes dissected on each side during surgery(9.91 ±3.44 vs.9.50±2.27,t=0.527,P=0.600),the positive rate of postoperative lymph node dissection(5/218 vs.8/314,P=0.852),postoperative hospital stay(6.91 ± 1.64d vs.7.19±1.56d,t=0.447,P=0.659),indwelling time of drainage tube(8.09 ±1.97d vs.7.63 ± 1.89d,t=0.618,P=0.542).There were 4 cases of complications in VEIL-H group,including 1 case of wound infection,2 cases of lymphatic cyst and 1 case of lower extremity edema.There were 5 cases of complications in VEIL-L group,including 2 cases of wound infection,1 case of lymphatic cyst and 2 cases of lower extremity edema.There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:1.Both VEIL-L and VEIL-H were feasible and safe methods for inguinal lymph node dissection of penile carcinoma.2.The preliminary results of our study indicated that VEIL-H is superior to VEIL-L in terms of operation time and blood loss,the former is easier to operate during the control of intraoperative bleeding and the need to dissect the surrounding lymph nodes such as the common iliac vessels.However,there was no significant difference in complications,total lymph node dissection,positive lymph node ratio,postoperative hospital stay and drainage tube indwelling time between the two groups.VEIL-H might more convenience when laparoscopic pelvic lymphadenectomy is required.3.Compared with the open inguinal lymph node dissection reported in the previous literature,both two methods could significantly reduce the occurrence of complications such as skin necrosis,and the effect of tumor control is similar to the open surgery.However,the long-term tumor cure rate requires further follow-up to reach a conclusion. |
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