PENILE cancer is a rare malignancy, but when diagnosed, it often requires inguinal lymphadenectomy to evaluate and treat regional lymph node involvement. The traditional approach, open inguinal lymphadenectomy (OIL), has long been the standard. However, recent advancements in minimally invasive techniques, including video endoscopic inguinal lymphadenectomy (VEIL), have raised questions about potential improvements in perioperative outcomes. A recent study assessed whether VEIL provides significant advantages over OIL, focusing on a variety of outcomes related to patient recovery and treatment efficacy. Notably, VEIL was found to reduce complications and recovery time in patients with penile cancer.
The meta-analysis was conducted through a systematic review of multiple databases up to June 2024. Only randomised controlled trials (RCTs) and prospective cohort studies were included. The analysis focused on key perioperative metrics such as operative time, perioperative complications (including wound infections, skin necrosis, and lymphoedema), drainage time, hospital stay, and oncological outcomes. Data was extracted from four studies, three RCTs and one non-randomised study, involving 95 patients and 174 operated limbs.
The results of the meta-analysis revealed significant benefits for VEIL over OIL. Notably, for patients undergoing VEIL, wound infections were significantly reduced (95% CI: 0.01–0.18; p<0.001), as were skin necrosis (95% CI: 0.04–0.09; p=0.002) and lymphoedema (95% CI: 0.09–0.99; p=0.05). Additionally, VEIL was associated with shorter drainage times (mean difference –1.94; 95% CI: –3.15––0.74; p=0.001) and reduced hospital stays (mean difference –5.48; 95% CI: –6.34––4.62; p<0.01). Pain intensity and operative time were also lower for the VEIL group, contributing to fewer postoperative complications. However, there were no significant differences in oncological outcomes between the two techniques.
In conclusion, the meta-analysis indicates that VEIL offers substantial advantages over OIL in reducing complications and improving recovery metrics, making it a promising technique in the management of penile cancer. However, the study’s limitations, particularly the small sample size of 95 patients, highlight the need for larger, more comprehensive randomised trials to confirm these findings. For clinical practice, these results suggest that VEIL may be a preferable option for patients with penile cancer, provided the technique is available and performed by trained surgeons.
Reference
Suartz CV et al. Comparing open and video endoscopic lymphadenectomy for penile cancer: a systematic review and meta-analysis of prospective studies. BJU Int. 2025;135(4):567-76
