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

•RAVEIL/VEIL can decrease skin-related complications like skin necrosis and wound infection, major complications, and lymphatic complications like lymphedema as compared to OILND in carcinoma penis.•RAVEIL/VEIL is equally adequate in terms of the blood loss, minor complications, lymphocele, and the...

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Published in:Urologic oncology 2022-03, Vol.40 (3), p.112.e11-112.e22
Main Authors: Patel, Keval N., Salunke, Abhijeet, Bakshi, Ganesh, Jayaprakash, Dipin, Pandya, Shashank J.
Format: Article
Language:English
Subjects:
Cancer of penis
Carcinoma - pathology
Humans
Inguinal Canal - pathology
Lymph Node Excision - adverse effects
Lymph Node Excision - methods
Lymphedema - etiology
Lymphedema - pathology
Lymphedema - surgery
Male
Meta-analysis
OILND
Penile Neoplasms - pathology
Penile Neoplasms - surgery
Penis - pathology
RAVEIL
Robotic Surgical Procedures - adverse effects
Robotic Surgical Procedures - methods
VEIL
Video-Assisted Surgery - methods
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Summary:•RAVEIL/VEIL can decrease skin-related complications like skin necrosis and wound infection, major complications, and lymphatic complications like lymphedema as compared to OILND in carcinoma penis.•RAVEIL/VEIL is equally adequate in terms of the blood loss, minor complications, lymphocele, and the number of lymph nodes dissected as compared to OILND.•By appearing to reduce the morbidity of inguinal node dissection perhaps minimally invasive surgery will increase the use of inguinal lymph node dissection in penile cancer, particularly as a staging operation in cN0 disease.•Large, multi-centric, high-quality RCTs with long-term follow-up in the future are required to provide substantial evidence for verification of the results. To perform a systematic review and meta-analysis evaluating the peri-operative outcomes, complications, and oncological outcomes of Robotic-Assisted Video-Endoscopic Inguinal Lymphadenectomy (RAVEIL)/Video-Endoscopic Inguinal Lymphadenectomy (VEIL) with Open Inguinal Lymph-Node Dissection (OILND) for management of inguinal lymph-nodes in carcinoma of the penis. A comprehensive literature search was performed in January 2021 using the PubMed, Embase, and Cochrane databases. Data from human studies comparing RAVEIL/VEIL vs. OILND in carcinoma of penis published in English was extracted and analyzed by two independent authors. Two Randomised Controlled Trials and 6 cohort studies were included in the meta-analysis. RAVEIL/VEIL group exhibited increased operative time (Mean Difference [MD] = 15.28 [14.19; 16.38], P < 0.001), shorter hospital stay (MD = -1.06 [-1.14; -0.98], P < 0.001), and decreased duration of drainage (MD = -2.82 [-3.21; -2.43], P < 0.001), wound infection (Odds Ratio [OR] = 0.15 [0.08; 0.27], P < 0.001), skin necrosis (OR = 0.12 [0.05; 0.28], P < 0.001), lymphedema (OR = 0.41 [0.24; 0.72], P = 0.002), and major complications (OR = 0.11 [0.05; 0.24], P < 0.001) as compared to OILND group. Recurrence rate and number of deaths were comparable in both the groups. RAVEIL/VEIL groups showed slightly larger lymph-node yield (MD = 0.44 [0.18; 0.70], P < 0.001) as compared to OILND group. RAVEIL/VEIL has lesser skin complications, lymphedema, and better lymph-node yield as compared to OILND. It is comparable in terms of lymphocele and recurrence. It has lesser hospital stay and duration of drainage but owing to heterogeneity, the results should be interpreted with caution. Further studies are required to determine long-term on
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2021.11.010