Comparing open and video endoscopic lymphadenectomy for penile cancer: a systematic review and meta-analysis of prospective studies

IF 4.4 2区医学 Q1 UROLOGY & NEPHROLOGY BJU International Pub Date : 2025-01-24 DOI:10.1111/bju.16661

Caio Vinícius Suartz, Richard Dobrucki de Lima, Luiza Rafih Abud, Pedro Henrique Souza Brito, Ketlyn Assunção Galhardo, Thalita Bento Talizin, André Lopes Salazar, Fernando Korkes, Giuliano Guglielmetti, Stênio de Cássio Zequi, Leopoldo Alves Ribeiro-Filho, Paul Toren, Michele Lodde

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Abstract

Objective

To conduct the first meta-analysis using only prospective studies to evaluate whether video endoscopic inguinal lymphadenectomy (VEIL) offers advantages in perioperative outcomes compared to open IL (OIL) in patients with penile cancer.

Methods

A systematic review with meta-analysis was conducted across multiple databases, including Cochrane Central Register of Controlled Trials (CENTRAL), the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Latin America and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, and several trial registries up to June 2024. Only randomised controlled trials (RCTs) and prospective cohort studies were included. Data extraction focused on operative time, perioperative complications, drainage time, hospital stay, number of nodes retrieved and oncological outcomes.

Results

Four prospective studies, including three RCTs and one non-randomised study, were included in the analysis, totalling 95 patients and 174 operated limbs. VEIL demonstrated significantly fewer wound infections (P < 0.001; 95% confidence interval [CI] 0.01–0.18; I² = 0), skin necrosis (P = 0.002; 95% CI 0.04–0.49; I² = 0), and lymphoedema (P = 0.05; 95% CI 0.09–0.99; I² = 27%) compared to OIL. The VEIL group also had a shorter drainage period (P = 0.001; mean difference [MD] –1.94, 95% CI −3.15 to −0.74) and hospital stay (P < 0.01; MD –5.48, 95% CI −6.34 to −4.62). Pain intensity and operative time were lower in the VEIL group, contributing to fewer postoperative complications overall. Oncological outcomes showed no significant differences between the groups.

Conclusion

The meta-analysis indicates that VEIL offers significant advantages over OIL in terms of reducing wound infections, skin necrosis, and lymphoedema, leading to shorter hospital stays and overall improved perioperative outcomes. However, the limited sample of 95 patients across four studies underscores the need for further randomised trials and a cautious interpretation of the results, which currently support the use of VEIL in managing patients with penile cancer.

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比较开放和视频内镜下淋巴结切除术治疗阴茎癌：前瞻性研究的系统回顾和荟萃分析

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.