To compare outcomes between Robot assisted video endoscopic inguinal lymphadenectomy (RA-VEIL) and open inguinal lymph node dissection (OILND) in patients without bulky nodal metastasis in a tandem contemporary cohort.
Prospectively maintained hospital registry of patients undergoing RA-VEIL (51 patients) or OILND (100 patients) from 2012-2016 for groins without bulky nodal metastasis and minimum 9 months follow-up was retrospectively analyzed. Complications were graded by Clavien Dindo classification and nodal yield and disease recurrence on follow up were assessed. Elastic net regression was used to select variables associated with major complications (Clavien ≥3a) for multivariable analysis among plausible factors namely - age, diabetes, body mass index, smoking, nodal stage, surgery type, sartorius transposition, saphenous vein transection and adjuvant radiotherapy. Penalized Likelihood logistic regression methods were used for multivariate analysis to ascertain final effect sizes while accounting for sparse data bias.
RA-VEIL and OILND were comparable in median lymph node yield (13 vs 12.5). No patient experienced recurrence on median follow-up of 40 months. RA-VEIL had significantly lower hospital stay, days needing drain in situ, incidence of major complications, edge necrosis, flap necrosis and severe limb oedema. On multivariable analysis, pathological nodal stage [OR 2.8, 95% CI 1.1-6.8, p value 0.027] and OILND [OR 7.5, 95% CI 1.3-43, p value 0.024] emerged as independent risk factors associated with increased hazard of major complications.
RA-VEIL is a feasible technique allowing similar nodal yield while being associated with lower morbidity than OILND in patients without bulky groin adenopathy.
The Journal of urology. 2018 Jan 04 [Epub ahead of print]
Amitabh Singh, Jiten Jaipuria, Amit Goel, Swati Shah, Raghubir Bhardwaj, Saroj Baidya, Jalaj Jain, Chirag Jain, Sudhir Rawal
Department of Surgical Oncology - Uro-oncology division, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector - 5, New Delhi, India - 110085., Department of Surgical Oncology - Uro-oncology division, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector - 5, New Delhi, India - 110085. Electronic address: .