Comparing Outcomes of Open and Robot-Assisted Inguinal Lymphadenectomy for the Treatment of cN2 Squamous Cell Carcinoma of the Penis: A Retrospective Single-Center Analysis.

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.