Background: Inguinal lymph node (LN) dissection (iLND) is mandatory in cN2 penile squamous cell carcinoma (PSCC). Open iLND (OIL) is often omitted due to the high rate of complications. A minimally invasive approach may reduce morbidity; however, evidence supporting its role to treat bulky nodes is limited. This study aimed to present the outcomes of the largest European single-center series of robot-assisted iLND (RAIL) for the treatment of cN2 PSCC and to compare the surgical and survival outcomes of this approach with the standard of care. Methods: A retrospective analysis was conducted on men with cT1-4N2M0 PSCC undergone either OIL or RAIL at our institution from January 2014 onwards. Baseline demographics, perioperative data, and oncologic outcomes were analyzed. Results: Overall, 47 patients were included; 38 (81%) underwent OIL. Median age was 59 years, with 23 men (48%) presenting with a ≥4 Charlson comorbidity index. Operation time was significantly longer in the robotic cohort (212 min vs. 145 min;p< 0.001), while the length of stay (p= 0.09) and time to inguinal drainage removal (p= 0.08) were not. Estimated blood loss favored the robotic approach (60 mL vs. 300 mL;p< 0.001). Post-operative complications rates were comparable in the two groups (25% vs. 47%;p= 0.17): four major complications were observed overall, and these were all in the OIL cohort. Median LN yield was comparable between the two groups (18 vs. 25;p= 0.05). Final pathology reports showed no significant differences in tumor stage distribution between the cohorts (p= 0.54). Kaplan–Meier analysis did not reveal any significant differences in RFS probabilities between the two treatment groups (Log Rank = 0.99). Conclusions: RAIL demonstrated comparable perioperative and oncologic outcomes to OIL for cN2 PSCC, with the benefit of reduced estimated blood loss. RAIL is a feasible option for cases where a minimally invasive approach is preferred, offering comparable perioperative safety and oncological outcomes.
背景：对于cN2期阴茎鳞状细胞癌（PSCC），腹股沟淋巴结清扫术（iLND）是必要的治疗手段。开放性腹股沟淋巴结清扫术（OIL）常因并发症发生率高而被规避。微创手术方式可能降低并发症发生率，但其在治疗肿大淋巴结方面的作用尚缺乏充分证据支持。本研究旨在呈现欧洲最大单中心系列cN2期PSCC患者接受机器人辅助腹股沟淋巴结清扫术（RAIL）的治疗结果，并将该术式与标准治疗方案的手术及生存结局进行比较。 方法：对2014年1月以来在本机构接受OIL或RAIL治疗的cT1-4N2M0期PSCC男性患者进行回顾性分析。收集并分析患者基线人口统计学特征、围手术期数据和肿瘤学结局。 结果：共纳入47例患者，其中38例（81%）接受OIL治疗。中位年龄59岁，23例患者（48%）查尔森合并症指数≥4。机器人手术组手术时间显著延长（212分钟 vs. 145分钟；p<0.001），而住院时间（p=0.09）和腹股沟引流管拔除时间（p=0.08）无显著差异。机器人手术组预估失血量显著减少（60 mL vs. 300 mL；p<0.001）。两组术后并发症发生率相当（25% vs. 47%；p=0.17）：共观察到4例严重并发症，均发生在OIL组。两组淋巴结清扫数量中位数相近（18枚 vs. 25枚；p=0.05）。最终病理报告显示两组肿瘤分期分布无显著差异（p=0.54）。Kaplan-Meier分析表明两组无复发生存概率无显著差异（对数秩检验=0.99）。 结论：对于cN2期PSCC，RAIL在围手术期和肿瘤学结局方面与OIL相当，且具有减少预估失血量的优势。在倾向于微创手术的病例中，RAIL是可行选择，能提供相当的围手术期安全性和肿瘤学结局。
肿瘤(癌症)患者之家