Background: Long-term survival in penile cancer is dependent on the presence and extent of lymph node metastases. Historically, inguinal lymph node dissection (ILND) has been performed via an open approach (O-ILND). More recently, minimally invasive surgical alternatives (MIS-ILND) such as video-endoscopic and robot-assisted ILND have emerged. This review aims to compare the (1) perioperative outcomes, (2) complication rates, and (3) oncological efficacy between O-ILND and MIS-ILND. Methods: We conducted a PRISMA-compliant meta-analysis including studies comparing O-ILND versus MIS-ILND for penile cancer. Outcomes were pooled in random-effects meta-analyses. Results: Sixteen articles comprising 1054 patients were analysed. There was an observed trend towards longer operative time for the MIS-ILND approach (mean difference 28 min; 95% CI −2 to 58 min,p= 0.06), particularly with the robotic-assisted technique. Total LN yield (mean 12.3, mean difference 0.3, 95% CI −0.3 to 0.9,p= 0.13), and positive LN (RR 0.98, 95% CI 0.88–1.10,p= 0.75) were similar between groups. MIS-ILND significantly reduced complication rates for both minor (RR: 0.65, 95% CI 0.45–0.94,p= 0.02) and major complications (RR: 0.25, 95% CI 0.12–0.53,p= 0.002). Particularly, there was also lower wound infection rate with MIS-ILND (RR: 0.43, 95% CI 0.22–0.82,p= 0.02), corresponding to a shorter hospital stay of average 4 days (MD −4, 95% CI −6–−2,p= 0.05). Rates of skin/flap necrosis, lymphedema, lymphocele, and drainage time did not differ significantly. Local groin recurrence and overall survival did not differ between approaches. Conclusions: MIS-ILND is associated with fewer perioperative complications and shorter hospitalisation without compromising oncologic outcomes. These findings support its broader adoption, particularly in high-volume centres with appropriate surgical expertise.
背景：阴茎癌的长期生存取决于淋巴结转移的存在与否及其范围。传统上，腹股沟淋巴结清扫术（ILND）通过开放手术（O-ILND）进行。近年来，出现了微创手术替代方案（MIS-ILND），如视频内镜和机器人辅助的ILND。本综述旨在比较O-ILND与MIS-ILND在（1）围手术期结果、（2）并发症发生率以及（3）肿瘤学疗效方面的差异。 方法：我们进行了一项符合PRISMA标准的荟萃分析，纳入了比较O-ILND与MIS-ILND治疗阴茎癌的研究。采用随机效应模型对结果进行汇总分析。 结果：共分析了16篇文章，涉及1054名患者。观察到MIS-ILND（尤其是机器人辅助技术）的手术时间有延长趋势（平均差异28分钟；95% CI -2至58分钟，p=0.06）。两组在总淋巴结获取数（平均12.3枚，平均差异0.3，95% CI -0.3至0.9，p=0.13）和阳性淋巴结检出率（RR 0.98，95% CI 0.88–1.10，p=0.75）方面相似。MIS-ILND显著降低了轻微并发症（RR: 0.65，95% CI 0.45–0.94，p=0.02）和严重并发症的发生率（RR: 0.25，95% CI 0.12–0.53，p=0.002）。特别是，MIS-ILND的伤口感染率更低（RR: 0.43，95% CI 0.22–0.82，p=0.02），对应平均住院时间缩短4天（MD -4，95% CI -6至-2，p=0.05）。皮肤/皮瓣坏死、淋巴水肿、淋巴囊肿的发生率以及引流时间无显著差异。两种手术方式的局部腹股沟复发率和总生存率无差异。 结论：MIS-ILND在不影响肿瘤学疗效的前提下，与更少的围手术期并发症和更短的住院时间相关。这些发现支持其更广泛的应用，特别是在具备相应手术专业能力的高手术量中心。
肿瘤(癌症)患者之家