Bilateral Inguinal Lymphadenectomy Research Articles

Adjuvant Radiotherapy for Groin Node Metastases Following Surgery for Vulvar Cancer: A Systematic Review

Background: Lymph node metastasis in vulvar cancer is a critical prognostic factor associated with higher recurrence and decreased survival. A survival benefit is reported with adjuvant radiotherapy but with potential significant morbidity. We aim to clarify whether there is high-quality evidence to support the use of adjuvant radiotherapy in this setting.Objectives: The aim of the study was to assess the effectiveness and safety of adjuvant radiotherapy to locoregional metastatic nodal areas.Search Methods: We conducted a comprehensive and systematic literature search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, ClinicalTrials.gov, and the National Cancer Institute. We considered only randomized controlled trials (RCTs).Main Results: We identified 1,760 records and finally retrieved only one eligible RCT (114 participants with positive inguinofemoral lymph nodes). All women had undergone radical vulvectomy and bilateral inguinal lymphadenectomy and had been randomized to adjuvant radiotherapy or to intraoperative ipsilateral pelvic lymphadenectomy without adjuvant radiotherapy. At 6 years, the overall survival (OS) was 51% versus 41% in favor of radiotherapy (HR 0.61; 95% CI 0.30–1.3) without significance and with very low certainty of evidence. At 6 year, the cumulative incidence of cancer-related deaths was 29% versus 51% in favor of adjuvant radiotherapy (HR 0.49; 95% CI 0.28–0.87). Recurrence-free survival at 6 years was 59% after adjuvant radiotherapy versus 48% after pelvic lymphadenectomy (HR 0.39; 95% CI 0.17–0.88). Three (5.3%) versus 13 (24.1%) groin recurrences were noted, respectively, in the adjuvant radiotherapy and pelvic lymphadenectomy groups. There was no significant difference in acute toxicities for pelvic lymphadenectomy compared to radiotherapy. In women with positive pelvic lymph nodes (20%), the OS at 6 year was 36% compared with 13% in favor of adjuvant radiotherapy. Late cutaneous toxicity rate appeared to be greater after radiotherapy (19% vs. 15%) but with less chronic lymphedema (16% vs. 22%).Conclusion: There is only very low-quality evidence on administering adjuvant radiotherapy for inguinal lymph node metastases. Although the identified study was a multicenter RCT, there was a reasonable imprecision and inconsistency because of small study numbers, wide confidence intervals in the data, and early trial closure, resulting in downgrading of the evidence.

Clinical Characteristics of Basal Cell Carcinomas of the Scrotum: An Institutional Retrospective Review

Objective. To analyse the clinical and pathologic features, discuss therapeutic strategies, and possibly cause and identify prognostic factors of scrotal basal cell carcinoma (BCC) in Chinese patients. Materials and Methods. Between January 2012 and December 2022, 12 patients with scrotal BCC were diagnosed and treated at our institution. A review was conducted based on the clinical characteristics, pathology slides, and tissues of these patients. Results. The median patient age was 69.26 ± 11.23 years. The skin lesions presented as red papules, blue-grey polypoid nodules, erythematous patches, brownish plaques, and so on. All patients were treated using wide excision, but the margins varied from 0.5 cm to 2 cm. HPV infection was checked in all lesions, with 4 out of 12 testing positive for P16 and 1 for HPV16 DNA. We found mottled positive expression of P16 in the cytoplasm and membrane. One patient developed left inguinal lymph node metastasis and was successfully treated using bilateral inguinal lymphadenectomy. The rest recovered well without relapse. Conclusions. BCC of the scrotum is rare, but long-term surveillance is recommended for BCC patients, and whether genital HPV infection is a noteworthy feature for these patients remains under investigation.

A case report of early detection of rare femoral shaft bone metastasis in a penis cancer patient

Background. Bone metastasis is very common in the advanced stage of numerous carcinomas. In penile carcinoma, lymph nodes metastasis is somehow common but it is very rare reported to be secondary from penile cancer. till the date, there are only few cases of penis carcinoma reported bone metastasis in literature worldwide.Case Presentation. Herein, We presented a 51-year-old Nepalese male with squamous cell carcinoma of penis. computed tomography (ct) scan of the patient revealed that there was carcinoma involving glans penis and precure with bilateral external & internal inguinal lymphadenopathies. After then, the patient was under gone for partial penectomy and bilateral inguinal lymphadenectomy and complete 6-cycle chemotherapy. After one year of treatment, patient developed thigh pain and headache and he advised to have magnetic Resonance imaging (mRi) of brain, 99mTc-MDP whole body bone scan and ct scan of pelvis and thigh. The examination report reveals that there was a sclerotic change in vertex of skull bone and moderate 99mTc-MDP uptake in right proximal shaft of femur just below the neck d/d metastasis. The histopathological examination of the true cut biopsy taken from the lesion of the femur showed metastatic keratinizing squamous cell carcinoma which is rare case of femoral shaft bone metastasis secondary from penile carcinoma. Then patient was sent for surgical reconstruction of femur. Based on the case studies review femur shaft bone metastasis from penile cancer is extremely rare.Conclusion. The best of our knowledge; this is the first early detected bone metastases to shaft of the femur in a patient with penile cancer. early diagnosis helps to radical treatment as well as palliative treatment. surgery is the preferred option of the treatments, especially for metastatic foci in the long bones.

Bilateral Lateral Video Endoscopic Inguinal Lymphadenectomy in a Patient with Penile Malignancy

Bilateral Lateral Video Endoscopic Inguinal Lymphadenectomy in a Patient with Penile Malignancy

(388) Primary Penile Squamouse Cell Cancer Related Malignant Priapism In A Cystectomized Patient: A Case Report

Abstract Introduction Priapism is a prolonged (> 4 hours) and unintended erection without sexual stimulation or sexual desire. Priapism due to neoplasms is called malignant priapism, which is a rare condition that tends to occur with corporeal metastasis of other pelvic area malignancies. Priapism due to primary penile malignancies is extremely rare. Objective In this article, we present the case of a patient who underwent total penectomy and bilateral inguinal lymphadenectomy due to malignant priapism related to primary penile squamous cell cancer (SCC), and who also underwent radical cystectomy (RC) and total urethrectomy due to urothelial carcinoma 19 and 2 years prior, respectively. Methods We prepared the patient's information to present. Results An 82-year-old male patient presented to an outpatient clinic with unintended erection and penile pain of about 48 hours’ duration and was on follow-up in our clinic because of urothelial carcinoma history. The patient’s history indicated that he underwent RC and orthotopic neobladder due to muscle-invasive urothelial cancer (UC) in the bladder. No tumor was observed in the final cystectomy pathology; therefore, no adjuvant therapy was given. Seventeen years after the RC operation, he presented with hematuria and a papillary lesion detected in the mid-urethra during cystourethroscopy. Since the biopsy result from this region was compatible with high-grade UC, he underwent total urethrectomy, neobladder resection, and ileal conduit. Urethrectomy pathology results were reported as UC invading the subepithelial stroma and lymphovascular area. Adjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy was administered. On follow-up 2 years after the urethrectomy operation, he presented with prolonged priapism. On examination, a cold and erect penis with a 1 cm diameter ulcerated lesion on the glans penis were observed. Hypoxia and hypercarbia were observed on the cavernosal blood gas examination, which was compatible with ischemic priapism. The hemogram was normal. On the emergent penile duplex Doppler ultrasound showed decreased blood flow and a mass on the proximal part of the penis. Subsequently, pelvic magnetic resonance imaging was performed and a mass was observed that was fully destructive to the cavernosal bodies and had irregularly circumscribed borders (Figure 1). Afterward, the patient underwent a total penectomy and bilateral inguinal lymphadenectomy. The pathology report from the penectomy material suggested that the tumor was compatible with moderately differentiated SCC. No sign of metastasis was observed in the lymph nodes. Extensive sampling of the tumor did not reveal any UC in situ, nor SCC in situ. The penis shaft was fully infiltrated by the tumor, with SCC morphology starting from the surgical margin and damaging all the structures of the penile body (Figure 2). The patient was transferred to the oncology clinic for additional treatment planning. Conclusions Despite being the most common primary malignancy of the penis, to the best of our knowledge priapism due to primary penile SCC has been reported only once in the literature. Although metastatic disease is typically thought to be the cause, when a patient with a history of pelvic malignancy presents with malignant priapism, it should be kept in mind that primary malignancies of the penis may also cause this condition. Disclosure No

Treatment of an Inguinal Lymphatic Fistula with Indocyanine Green

<h3>Study Objective</h3> To address iatrogenic lymphocele after inguinal lymphadenectomy for vulvar cancer with a minimally invasive intervention, by localizing the disrupted lymphatic duct with real-time NIR/ICG fluorescent imaging. <h3>Design</h3> Narrated video footage. <h3>Setting</h3> Department of Gynecologic Oncology, Bern University Hospital. <h3>Patients or Participants</h3> Patient A underwent hemivulvectomy with homolateral inguinal sentinel lymphadenectomy for a squamous cell carcinoma of the right vulva, FIGO Ib. Two weeks later she reported a wound dehiscence in her right groin with abundant yellowish discharges, persisting over time and leading to a remarkable progression of the dehiscence. Patient B was seen after R1 resection of a relapsing FIGO II, already treated with combined chemoradiotherapy one year before. She underwent dorsal hemivulvectomy with bilateral inguinal lymphadenectomy, complete colpectomy and coverage of tissue defects with fascio-cutaneous flaps. Two weeks later she reported a closed inguinal lymphocele. We attempted a conservative treatment with antibiotics and needle aspirations, nevertheless a multibacterial infection occurred on the right side. <h3>Interventions</h3> By failing conservative measures, surgical correction of assumed lymphatic fistulas was called for in both cases. After debridement of the inguinal wound in local anesthesia, an intracutaneous injection of 2 ml ICG was carried out between the 1st and 2nd ipsilateral toe. <h3>Measurements and Main Results</h3> After 7 minutes a fluorescent effusion from the site of the fistula was identified in real-time NIR imaging, performed with an optic device (VITOM® ICG) installed on the operating table for the extracorporeal detection of the fluorescence produced by ICG. The disrupted lymphatic duct could be ligated. The absence of further fluorescent effusion confirmed the successful repair. The wound was closed and healed well in the follow-up. No recurrence or exacerbation of the lymphedema occurred. <h3>Conclusion</h3> Intraoperative NIR/ICG fluorescence lymphatic imaging with an exoscope enables a highly sensitive detection of lymphatic structures and a tailored curative intervention, with a safe toxicological profile and without radiation exposure.

V11-11 ROBOTIC-ASSISTED INGUINAL LYMPHADENECTOMY FOR PENILE CANCER: STEP-BY-STEP TECHNIQUE

You have accessJournal of UrologyCME1 May 2022V11-11 ROBOTIC-ASSISTED INGUINAL LYMPHADENECTOMY FOR PENILE CANCER: STEP-BY-STEP TECHNIQUE Alberto Piana, Josep Maria Gaya, Pietro Diana, Andrea Gallioli, Antonio Rosales, Pavel Gavrilov, Angelo Territo, Joan Palou, and Alberto Breda Alberto PianaAlberto Piana More articles by this author , Josep Maria GayaJosep Maria Gaya More articles by this author , Pietro DianaPietro Diana More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Antonio RosalesAntonio Rosales More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Angelo TerritoAngelo Territo More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002632.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile cancer metastasis follows a well established predictable pattern, being not possible to have distant metastasis without positive inguinal nodes. Therefore, in penile cancer inguinal lymphadenectomy have diagnostic and therapeutic value. Despite robust evidences, many urologists still do not indicate this surgery. Centralization and minimally invasive techniques showed to improve oncological outcomes (overall survival and cancer specific survivor) and to decrease morbidity. METHODS: We present a clinical case of a 51 years old patient underwent robotic-assisted bilateral inguinal lymphadenectomy performed after previous glandectomy and Bracka reconstruction. Pathology showed squamous cell carcinoma pT2, negative margins, p16 negative and no palpable nodes on physical exam of the groin. Because of clinical staging cN0 and the high risk of metastasis, according to the EAU Guidelines, we performed robotic-assisted inguinal lymphadenectomy (RAIL). Da Vinci X system with 3 arms was used and an extra 5mm trocar for the assistant was placed. RESULTS: Surgical time was 210 min and EBL <50 mL. Final pathology was 8 negative nodes in the right groin and 8 negative nodes in the left groin. Drainages were removed after 3 weeks and no major complications were reported. CONCLUSIONS: RAIL is a safe technique with same oncological indications and outcomes with less morbidity and less morbidity compared to the open approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e924 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Piana More articles by this author Josep Maria Gaya More articles by this author Pietro Diana More articles by this author Andrea Gallioli More articles by this author Antonio Rosales More articles by this author Pavel Gavrilov More articles by this author Angelo Territo More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF DownloadLoading ...

Single-position robot-assisted versus laparoscopic antegrade bilateral inguinal lymphadenectomy for penile cancer: A retrospective controlled study

ObjectivesThe main purpose of this study was to compare the surgical strategy and clinical outcomes of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer. Materials and methods21 patients were diagnosis with squamous cell carcinoma and identified from March 2010 to December 2020 in our department. Ten patients were received single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy (robot-assisted group), and eleven patients underwent laparoscopic inguinal lymphadenectomy (laparoscopic group). Preoperative physical examination and related auxiliary examinations all indicated bilateral inguinal lymph node enlargement, and there was no distant metastasis patient presented during the follow-up period. ResultsThere was no intraoperative conversion to open surgery. The operation time under robot-assisted group was 104 ± 13 min which was significantly shorter than laparoscopic group (136 ± 11 min, P < 0.01). The average number of lymph nodes was 22.2 ± 4.5 of both sides in robot-assisted group, which was statistically different compared with laparoscopic group (15.4 ± 3.1, p < 0.01). Moreover, there was significant difference of hospitalization cost between two groups (CNY 67429 ± 5586 vs 28582 ± 3774, P < 0.01). No differences in operation time, blood loss, and length of stay were recorded. ConclusionsThe single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy reveals with shorter operating time, and better surgical effect, Moreover, we prefer to no change the trocars layout and mechanical arm system during the operation.

Bilateral inguinal lymphadenectomy using simultaneous double laparoscopies for penile cancer: A retrospective study.

To assess the feasibility, safety, and efficiency of bilateral inguinal lymphadenectomy using simultaneous double laparoscopies for penile cancer. We reviewed retrospectively the records of 65 patients who underwent inguinal lymph nodes dissection (ILND) for penile cancer from January 2012 to May 2019. Treatments included open ILND (OILND, 19 patients), video-endoscopic inguinal lymphadenectomy (VEIL) using single laparoscopy (S-VEIL, 24 patients), and VEIL using double laparoscopies (D-VEIL, 22 patients). We evaluated the peri-operative and short-term oncological outcomes of the three groups. The mean operative time of D-VEIL (105.91 ± 10.87 minutes) was significantly shorter than the other two groups, OILND shorter than S-VEIL (160.47 ± 13.74 minutes, 191.67 ± 17.80 minutes, respectively) (P < 0.001). Intraoperative blood loss in the S-VEIL and D-VEIL groups were 53.54 ± 8.78 and 48.41 ± 13.22 ml, respectively; they were significantly lower than that of the OILND group (99.74 ± 9.64 ml; P < 0.001). The numbers of unilateral and total lymph nodes harvested were similar in all groups. The complication rates in the S-VEIL group (4.2%) and the D-VEIL group (4.5%) were significantly lower than that in the OILND group (63.2%; P < 0.001). Compared with open surgery (13.53 ± 1.74 days for hospitalization; 11.37 ± 1.92 days for the left side of drain, 11.95 ± 1.84 days for the right side), the two VEIL groups had significantly shorter drainage tube residence time (7.42 ± 2.02 and 7.32 ± 1.52 days, respectively for the left side; 7.63 ± 1.81 and 7.27 ± 1.58 days, respectively for the right side), shorter postoperative hospitalization (9.46 ± 1.64 and 9.00 ± 1.83 days, respectively) (P < 0.001). There were no statistically significant differences in rates of regional recurrence and short-term survival among the three groups. Bilateral inguinal lymphadenectomy using double laparoscopies simultaneously can provide adequate oncological outcomes safely and efficiently, and carry significantly lower morbidity than OILND, at a median follow-up of 33.5 months. It is a more time-saving surgical approach for penile cancer patients who need bilateral ILND.

Primary urethral carcinoma: Results from a single center experience

Introduction and aim of the studyPrimary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra. Materials and methodsMedical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN+ with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease (<T2) and/or more distal tumors underwent urethrectomy or partial penectomy. Kaplan–Meier curves were evaluated for analysis of overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). ResultsA total of 13 male patients with anterior PUC were studied retrospectively. Total penectomy was performed in 7 cases, while partial urethrectomy was performed in 5 cases, and partial penectomy in 1 case. Of the 7 patients who underwent total penectomy, 5 underwent radical cystectomy with bilateral inguinal lymphadenectomy. Three patients were treated with neoadjuvant systemic chemotherapy, of which 2 were cT3N+ and 1 was cT3N0. The predominant histologic subtype was squamous cell carcinoma (SCC), found in 7 patients (53.8%), while urothelial carcinoma (UC) was present in 5 patients (38.5%) and a malignant fibro-histiocytoma in 1 case. Most patients were diagnosed at advanced stages of the disease, with T2 tumors in 15.4% and T3 tumors in 46.2% of the cases. Median follow-up was 24 months (range 1–294). After surgical treatment, 8 patients (61.5%) presented disease recurrence after a median of 6.3 months, with a 5-year RFS of 58% ± 14%. The 5-year OS rate was 50% ± 14% while the 5-year CSS rate was 66% ± 13%. ConclusionGiven its rarity, urethral carcinoma should be treated in a referral center. Treatment options include a radical approach or penile-preserving surgery (urethrectomy or partial penectomy) in cases of localized disease. Due to the high recurrence rate, strict follow-up is mandatory.

Carcinoma uretral primario: resultados de la experiencia de un único centro

Introduction and aim of the studyPrimary urethral carcinoma (PUC) is a rare neoplastic disease arising in the urethra, without any evidence of a previous or synchronous carcinoma of the entire urinary tract. Since rare diseases are often incorrectly diagnosed and managed, the aim of this study was to analyze the experience of a single urology center in the treatment of PUC, focusing on neoplasms arising from the male anterior urethra. Materials and methodsMedical records of patients with neoplasms at the level of the penile and bulbar urethra who presented at our tertiary referral center between January 1988 and December 2018 were retrospectively reviewed. Patients with carcinoma of the prostatic urethra were excluded. The diagnosis was obtained with the aid of urethroscopy and lesion biopsy. Local staging was performed by means of contrast-enhanced MRI in selected patients. Staging was achieved by clinical examination, ultrasonography, and CT scan. Radical surgery (radical cystectomy + total penectomy + bilateral inguinal lymphadenectomy) was proposed to patients with ≥T2 tumors or cN + with a good performance status, proximal tumor and without severe comorbidities. In case of nodal involvement, neoadjuvant chemotherapy was additionally offered. Patients with localized disease (<T2) and/or more distal tumors underwent urethrectomy or partial penectomy. Kaplan-Meier curves were evaluated for analysis of overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). ResultsA total of 13 male patients with anterior PUC were studied retrospectively. Total penectomy was performed in 7 cases, while partial urethrectomy was performed in 5 cases, and partial penectomy in 1 case. Of the 7 patients who underwent total penectomy, 5 underwent radical cystectomy with bilateral inguinal lymphadenectomy. Three patients were treated with neoadjuvant systemic chemotherapy, of which 2 were cT3N + and 1 was cT3N0. The predominant histologic subtype was squamous cell carcinoma (SCC), found in 7 patients (53.8%), while urothelial carcinoma (UC) was present in 5 patients (38.5%) and a malignant fibro-histiocytoma in 1 case. Most patients were diagnosed at advanced stages of the disease, with T2 tumors in 15.4% and T3 tumors in 46.2% of the cases. Median follow-up was 24 months (range 1–294). After surgical treatment, 8 patients (61.5%) presented disease recurrence after a median of 6.3 months, with a 5-year RFS of 58%±14%. The 5-year OS rate was 50%±14% while the 5-year CSS rate was 66%±13%. ConclusiónGiven its rarity, urethral carcinoma should be treated in a referral center. Treatment options include a radical approach or penile-preserving surgery (urethrectomy or partial penectomy) in cases of localized disease. Due to the high recurrence rate, strict follow-up is mandatory.

Indocyanine green fluorescence imaging, sentinel lymph node mapping in patients with vulvar cancer: peritumoral injection dosage and waiting times in our experience

BackgroundVulvar cancer is a rare gynecological malignancy that primarily affects women of postmenopausal age. Treatment is mainly surgical, particularly for vulvar squamous cell carcinoma, the most prevalent histotype. In patients with unifocal tumors with a maximum diameter of <4 cm, in the absence of suspected inguinal lymph nodes, sentinel lymph node (SLN) biopsy is recommended. The use of a radioactive tracer is mandatory; the use of the vital blue dye is optional.ResultsTwo patients diagnosed with vulvar squamous cell carcinoma (FIGO IB stage) underwent bilateral radical vulvectomy, SLN search and removal, and bilateral inguinal lymphadenectomy at the Cannizzaro Hospital Operative Unit of Obstetrics and Gynecology Department (Catania, Italy). Three milliliters of indocyanine green (ICG) 0.5 mg/mL was administered in 3 peritumoral injections under general anesthesia to screen the SLN. The images were acquired using an intraoperative infrared camera system, which allowed intraoperative visualization of the SLN. An SLN was identified for each patient. The lymph nodes examined by the pathologist were negative for metastatic localization of the disease. However, patients underwent bilateral inguinofemoral lymphadenectomy, as this procedure is not currently codified as a gold standard for the detection of SLN in vulvar cancer. All the lymph nodes removed were negative for the localization of vulvar carcinoma metastases.ConclusionsThe potential of the administration of indocyanine green (ICG) allows the execution of SLN biopsy, avoiding the multiple administrations of radiocolloid in the pre-operative phase, painful for the patient, elimination, and exposure to radioactivity. Therefore, while requiring standardization of the methodology and a large-scale application, this procedure could open a new surgical management perspective in patients with early-stage vulvar cancer.

Port Site Squamous Cell Carcinoma Following Video Endoscopic Inguinal Lymphadenectomy

Port site metastasis is one of the feared complications following laparoscopic oncosurgery. We present the case report of port site recurrence following video endoscopic inguinal lymphadenectomy (VEIL) for carcinoma penis. A 54-year-old gentleman had undergone total penectomy with bilateral videoendoscopic inguinal lymphadenectomy 2 years back. Histopathology was reported as well-differentiated squamous cell carcinoma. Fifteen nodes on the right side and 8 nodes in the left were found negative for tumour. Ten months later, he presented with an indurated swelling in right mid-thigh with serous discharge at the site of camera and extraction port of VEIL. Core needle biopsy was done and reported as moderately differentiated squamous cell carcinoma. PET CT was done, and no other sites of activity were seen. Hence, wide local excision of the lesion with local rotation flap cover was done. Right iliac lymphadenectomy was done. The histopathology confirmed negative margins. Twelve iliac lymph nodes were negative for tumour. He received 3 cycles of cisplatin-based chemotherapy. This is the first case report of port site recurrence of squamous cell carcinoma following VEIL. The probable mechanisms are pneumatic spread or spill during extraction. The possibility of second primary should also be considered, due to negative lymph nodes in first biopsy. Port site recurrence is a rare but definite possibility following VEIL. Precautions should be taken like preventing air leak, using extraction bag and avoiding trocar slip to decrease the incidence of port site recurrence.

145 - Saphenous vein sparing during laparoscopic bilateral inguinal lymphadenectomy dose not benefit for penile carcinoma patients: A prospective randomized controlled study

145 - Saphenous vein sparing during laparoscopic bilateral inguinal lymphadenectomy dose not benefit for penile carcinoma patients: A prospective randomized controlled study

Melanoma peniano

Penile melanoma is a rare event, responsible for less than 1.4% of penile cancers. In general, it is late diagnosed and the treatment is usually aggressive. The authors present a 66-year-old Caucasian man who had an ulcerated penile lesion for 1 year, diagnosed as melanoma after biopsy and treated as locally advanced disease with partial penectomy, identification of the sentinel lymph node and bilateral inguinal lymphadenectomy.

The Rarest of Rare Penile Carcinomas: In Situ and Invasive Nodular Penile Melanomas on the Same Patient Clinical Case and Systematic Review

Introduction: Primary melanoma of the penile urethra and glans is a rare condition that accounts for less than 2% of all penile tumours,composes only 0.1% of total melanomas. Because of its great rarity, thisclinical case presentation is considered noteworthy for the scientific community, providing an exhaustive review of this pathology. Method: A literature search using PubMed search engine was conducted analysing latest reviews from the last 10 years using the terms “glans melanoma”. Only 18 results were found, most of them being published as case report. Second search is performed using the terms “urethra melanoma”, founding 7 review articles on the last 10 years in males. Although not all articles meet the requirements, and half of them are the same found in prior search. Finally, theoretical and epidemiology articles were selected in order to provide anatomical base and dermatological information. Results: 85-year-old male is diagnosed with melanoma in situ in glans and urethra by cold biopsy. The treatment includes total penectomywith perineal urethrostomyand bilateral inguinal laparoscopic lymphadenectomy. Conclusions: The risk factors for this type of pathology are not fully identified, so the follow-up of pigmented lesions in this area should be carried outby a specialist. Even though there is no consensus on melanoma, surgery is considered to be the first option with curative intention in localized tumours, though staging must be completed due their rapid dissemination and late diagnosis if there is no clinical suspicion. In the case of distant metastasis, the treatment does not differ from any other metastatic melanomas, where chemotherapy and immunotherapy are the cornerstone of the treatment.It is necessary to go in depth inthese clinical cases to elaborate clear guidelines for this pathology.

Posoncological Cutaneous Reconstruction of Penis with Scrotum Flaps about a Case

!Objective: The penile cancer is a rare entity in the developed countries and its incidence increases in the developing countries, achieving up to 10% of the malignancies in men. There is a crucial association with the HPV, in the same way it relates to inadequate hygiene habits and the phimosis. The objective of the surgical treatment is resection with adequate margins, and the inguinal lymph node dissection when indicated. The restore skin coverage in these lesions is a challenge for the surgeon, as it seeks to achieve a phallus almost normal appearance, and restore the patient's tactile and the erogenous function, with the fewest possible interventions, trying to minimize the psychological trauma. Previously, many of these patients were considered inoperable and were recommended to radiation therapy to cure the injury. The evolution of the plastic surgical techniques using skin or the myocutaneous flaps, have provided the surgeon another option to keep the local oncological control with acceptable morbidity. Clinical Case: The aim of this paper is to present the case of a 56 years old male patient with diagnostic of squamous cell cancer of the penis stage II, who underwent the penile stripping, with bilateral inguinal lymphadenectomy; and rotation flap reconstruction of the scrotal skin. We found no published paper about the skin reconstruction of penile skin flap from scrotum for cancer patients, hence the importance of this work. Keywords: Cancer, Penile, HPV, Reconstruction, Faloplastia.

Malignant hidradenoma of vulva in pregnancy-A rare case

Malignant hidradenoma of vulva in pregnancy-A rare case - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.121, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Robot-assisted laparoscopic antegrade versus open inguinal lymphadenectomy: a retrospective controlled study

BackgroundTo investigate the surgical methods and clinical results of robot-assisted laparoscopic antegrade inguinal lymphadenectomy.MethodsA retrospective study was performed on clinical data from 19 patients with penile cancer admitted from March 2013 to October 2017. Among them, nine patients underwent robot-assisted laparoscopic antegrade inguinal lymphadenectomy (robot-assisted group) and 10 patients underwent open inguinal lymphadenectomy (open group). In the robot-assisted group, preoperative preparation, patient position, robot placement, design of operating channel and establishment of operating space are described. Key surgical procedures and techniques are also summarized. In addition, the number of lymph nodes removed, postoperative complications and follow-up in both groups were statistically analyzed.ResultsFor the 9 patients in the robot-assisted group, surgery was successfully accomplished at 17 sides without intraoperative conversion to open surgery. The surgery time for each side was 45~90 min using laparoscope with an average of 68.5 ± 13.69 min/side. The intraoperative blood loss was estimated to be < 10 ml/side, and the number of removed lymph nodes was not significantly different from that of the open group (12 ± 4.2/side vs.11 ± 5.8/side, P = 0.84). There were no postoperative complications such as skin necrosis, delayed wound healing and cellulitis in the robot-assisted group. Skin-related complications occurred in 9 (45%) of the 20 sides in the open group. During a median follow-up of 25 months in robot-assisted group and 52.5 mouths in open group, was not significantly different there were no statistical differences in recurrence-free survival between the groups (75% vs 60%, p = 0.536).ConclusionRobot-assisted laparoscopic antegrade inguinal lymphadenectomy achieved the desired surgical outcomes with fewer intraoperative and postoperative complications. The robotic arms of the surgical system were placed between the lower limbs of each patient. There was no need to re-position the robotic arms during bilateral inguinal lymphadenectomy. This simplified the procedure and reduced the use of trocars. If necessary, pelvic lymphadenectomy could be performed simultaneously using the original trocar position.

Radical vulvectomy and inguinal lymphadenectomy using a single incision for the treatment of vulvar malignancy

Objective: To describe a novel procedure of radical vulvectomy and inguinal lymphadenectomy using a single incision (RVIL-SI) for the treatment of vulvar malignancy. Methods: In March, 2019, two cases affected with vulvar cancer (the first one is stage ⅢA squamous cell carcinoma and the second one is stage ⅠB with malignant melanoma) underwent this novel procedure, which was characterized by the combination of radical vulvectomy and bilateral inguinal lymphadenectomy without making additional incisions in groin areas. The boundaries of femoral triangle could be exposed perfectly using the initial incision of radical vulvectomy and the combined superficial and deep groin lymph node dissection were done subcutaneously from medial to lateral. Preoperative data and short term follow-up outcomes were collected. Results: The RVIL-SI was successfully conducted in two patients without any incisions of groin. The great saphenous veins were all spared. The operative time, average blood loss and median total regional lymph nodes of two cases were close. No major intraoperative complications occurred. Micrometastasis in one right superficial inguinal node was found in the first case with ipsilateral huge cancer lesion. No drain tube was left in inguinal areas intraoperatively. On postoperative day 3, the second case suffered mild lymphocele of right groin, which was resolved via repeated percutaneous needle puncture followed by elastic compression. Postoperative hospital stay of two cases were 10 and 11 days, respectively. With no skin complication at the time of writing this report. Conclusion: Our preliminary experience with the RVIL-SI has confirmed the reproducibility and minimal invasive therapeutic potential in the treatment for patients with vulvar cancer. But this novel procedure is in its infancy stage. Although short-term results are encouraging, a larger series with longer follow-up are required to fully evaluate the therapeutic efficacy.