Video-endoscopic versus open inguinal lymphadenectomy: Long-term oncological outcomes in penile cancer.

Introduction: Lymph node metastasis status is the strongest predictive factor for penile cancer survival. In penile cancer patients with suspected lymph node involvement, inguinal lymph node dissection (ILND) extends disease-free survival. Though video-endoscopic ILND (VEILND) has demonstrated superior surgical outcomes to open ILND (OILND) in the short term, its oncological efficacy long term is unproven. We present our long-term oncological follow-up of our previously published ILND cohort. Methods: A prospectively collected institutional database was used to determine the outcome in 42 consecutive patients treated for penile cancer in a tertiary referral centre between 2008 and 2015. Overall survival and cancer-specific survival (CSS) were calculated using Kaplan-Meier curves and compared via log-rank tests. Results: Forty-two patients underwent 68 ILND (35 OILND vs. 33 VEILND). Thirteen out of 42 patients were alive at a mean follow-up of 12.5 years. Overall survival for OILND and VEILND was 36.4% and 30.0% at 10 years. There was no significant difference between the survival curves (p = 0.91). CSS was equivalent (p = 0.87). Ten-year CSS was 75.3% (OILND) and 65.5% (VEILND). When stratified by nodal status, CSS for OILND was 77.8%, 83.3%, 50% and 66.7% (N0, N1, N2 and N3) compared with VEILND which were 100%, 75%, 75% and 40% respectively at 8 years. Thus, there was no significant difference in CSS between patients undergoing VEILND and OILND stratified by nodal status. Moreover, inguinal or pelvic nodal recurrence rate was equivalent in both groups, occurring in 5/22 OILND and 4/20 VEILND (p = 1.00) patients. Conclusion: To our knowledge, we present the first European report of long-term follow-up demonstrating the oncological safety of VEILND. VEILND has comparable outcomes of recurrence, overall survival and CSS, with significantly reduced complication rates and length of stay, in penile cancer at a median follow-up of 104 months (range 2-213 months).