977 ENDOSCOPC INGUINOFEMORAL LYMPHADENECTOMY FOR GENITOURINARY MALIGNANCIES

Abstract

INTRODUCTION AND OBJECTIVES: Inguinofemoral lymphadenectomy is a standard procedure for penile cancer patients but is also indicated for other genitourinary malignancies. Open lymphadenectomy is associated with complication rates exceeding 50% with lymphatic edema and secondary wound healing being most common. We present our experience with a modified endoscopic inguinofemoral lymphadenectomy (EL) in comparison with open surgery (OL). METHODS: All patients who underwent inguinofemoral lymphadenectomy for genitourinary malignancy were identified. Patients with palpable and non non-palpable nodes were included in the study. OL consisted of classical superficial and deep inguinofemoral lymph node dissection. EL was done using a 3-trocar approach. Lymph node dissection was done with respect to the same boundaries as in open surgery. We apply a reduced CO2-pressure of only 5 mmHg to reduce skin emphysema and CO2 absorption. A suction drain was always placed regardless of the technique used. Operative data and postoperative outcomes were assessed, and EL and OL were statistically compared regarding these parameters. RESULTS: We performed 50 inguinofemoral lymph node dissections in a total of 36 patients. Of those 18 procedures were completed endoscopically. Overall follow-up was 47.1 months (4–75). Mean operative time for OL was 102.5 minutes (38–195) being significantly shorter than for EL (152.1 minute, 110–186), p 0.001. Both groups are comparable with respect to the number of nodes harvested (OL 7.1, 2–16 vs EL 6.9, 4–13) as well as to the number of affected nodes (OL 1,8 vs EL 1,6). Mean age and range were comparable in both cohorts (OL 59.3 years, 17–80 vs EL 62.2 years, 52–77), p 0.35. However, the classical complications (Lymphatic edema, secondary wound healing) occurred extremely rare (1/18) after EL leaving an overall complication rate of 11.1%. In contrast to that, complications appeared in more than half of the OL-cases (56,2%) with secondary wound healing being the most common (n 16) followed by lymphatic edema (n 15). There were no problems recorded due to CO2-insufflation. CONCLUSIONS: Both OL and EL are reliable for inguinofemoral lymphadenectomy with regards to oncological efficacy. EL may be more technically challenging than OL reflected by a longer operative time. However, EL can avoid secondary wound healing and lymphatic stasis that are both extremely annoying complications. EL is safe with a low complication rate. A reduction of the CO2-pressure attributes to the safety profile. Oncological and functional endurance could be documented even in an extended follow-up.