Efficacy and Safety of Lateral Approach-Video Endoscopic Inguinal Lymphadenectomy (L-VEIL) over Open Inguinal Block Dissection: a Retrospective Study
This retrospective study compared the immediate post-operative short-term outcomes of Lateral Approach-Video Endoscopic Inguinal Lymphadenectomy (L-VEIL) and open surgery approach in patients with TNM stage N0 and N1 tumors. Inguinal lymphadenectomies performed for various TNM stage N0 and N1 cancers between January 2011 and December 2015 at a single center were analyzed by collecting data from operation theater records and case files. Mean blood loss, operative time, drain output, nodal yield, nodal positivity, and complications were analyzed as post-procedural outcomes. Among the 116 surgeries performed, 92 were open surgery and 24 were L-VEIL. Compared with open surgery, L-VEIL led to significantly lower blood loss (64.8 mL vs. 23.3 mL; p = 0.002), mean nodal yield (11.04 vs. 8.38; p = 0.001), and mean hospital stay (3.08 vs. 8 days; p < 0.001). However, the operative time was similar for both the groups (94.5 vs. 68.1 min; p = 0.08). Complications that were significantly low in L-VEIL were flap necrosis [RR 1.29; 95% CI (1.03–1.72); p < 0.001], wound dehiscence [RR 1.25; 95% CI (1.19–1.51); p = 0.005), wound infection [RR 1.34; 95% CI (1.19–1.51); p = 0.003], readmission [RR 1.3; 95% CI (1.17–1.44); p = 0.005], and re-surgery [p = 0.014]. Occurrence of complications such as lymphocele [RR 1.25; 95% CI (0.33–4.78); p = 0.5], lymphorrhea [RR 1.27; 95% CI (1.15–1.40); p = 0.5], and pedal edema [p = 0.2] were similar for both the approaches. L-VEIL was effective and safe compared with open inguinal block dissection in treatment of various TNM stage N0 and N1 urogenital and skin cancers.
KeywordsLateral approach-video endoscopic inguinal lymphadenectomy (L-VEIL) Inguinal block dissection Vulvar cancer Penile cancer Melanoma
The authors declare that they have no conflict of interest.
Study conceptualization and design: NSP, PH, GJ; data acquisition and analysis: NSP, PH, GJ, DK, CS, VM; manuscript writing and reviewing: NSP, PH, GJ; guarantor: NSP, PH, GJ, DK, CS, VM
- 4.World Health Organization. Skin cancers. https://www.who.int/uv/faq/skincancer/en/index1.html. Accessed 10 Jun 2019
- 18.Tobias-Machado M, Tavares A, Molina WR, Zambon JP, Medina JA, Forseto PH, Juliano RV, Wroclawski ER (2006) Video endoscopic inguinal lymphadenectomy (VEIL): initial case report and comparison with open radical procedure. Arch Esp Urol 59:849–852Google Scholar
- 19.Tobias-Machado M, Tavares A, Ornellas AA, Molina WR, Juliano RV, Wroclawski ER (2007) Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma. J Urol 177:953–957 discussion 958CrossRefGoogle Scholar
- 23.Clark PE, Spiess PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE, Herr HW, Inman BA, Kuban DA, Kuzel TM, Lele SM, Michalski J, Pagliaro L, Pal SK, Patterson A, Plimack ER, Pohar KS, Porter MP, Richie JP, Sexton WJ, Shipley WU, Small EJ, Trump DL, Wile G, Wilson TG, Dwyer M, Ho M, National Comprehensive Cancer Network (2013) Penile cancer: clinical practice guidelines in oncology. J Natl Compr Cancer Netw 11:594–615CrossRefGoogle Scholar
- 24.Stoffels I, Dissemond J, Schulz A, Hillen U, Schadendorf D, Klode J (2012) Reliability and cost-effectiveness of complete lymph node dissection under tumescent local anaesthesia vs. general anaesthesia: a retrospective analysis in patients with malignant melanoma AJCC stage III. J Eur Acad Dermatol Venereol 26:200–206CrossRefGoogle Scholar
- 26.Herrel LA, Butterworth RM, Jafri SM, Ying C, Delman KA, Kooby DA, Ogan KE, Canter DJ, Master VA (2012) Bilateral endoscopic inguinofemoral lymphadenectomy using simultaneous carbon dioxide insufflation: an initial report of a novel approach. Can J Urol 19:6306–6309Google Scholar
- 30.Dhangar SP, Kothawala I, Kumar A, et al (2016) Video Endoscopic Inguinal Lymphadenectomy (Veil): Experience from A Single Institute Study. Paripex-Indian J Res 5:4Google Scholar
- 33.Matin SF, Cormier JN, Ward JF, Pisters LL, Wood CG, Dinney CPN, Royal RE, Huang X, Pettaway CA (2013) Phase 1 prospective evaluation of the oncological adequacy of robotic assisted video-endoscopic inguinal lymphadenectomy in patients with penile carcinoma. BJU Int 111:1068–1074CrossRefGoogle Scholar
- 40.Mathevet P, Roy M, Dargent D. Inguinoscopy or video-endoscopic inguinal lymph node dissection.http://www.thetrocar.net. Accessed 10 Jun 2019