LYMPH NODE METASTASIS CHARACTERISTICS AND SURVIVAL OUTCOMES AFTER VIDEO ENDOSCOPIC INGUINAL LYMPHADENECTOMY FOR PENILE CANCER
Main Article Content
Abstract
Objectives: To characterize inguinal lymph node metastasis and evaluate survival outcomes after video endoscopic inguinal lymphadenectomy (VEIL) in penile cancer patients, and to identify predictors of nodal metastasis.
Methods: A prospective descriptive case series of 38 penile cancer patients who underwent bilateral VEIL at Binh Dan Hospital from May 2023 to June 2025. Analysis included lymph node metastasis characteristics (pN staging, extranodal extension), predictors of pN positivity using Fisher’s exact test, and survival outcomes (disease-free survival, overall survival).
Results: The pN (+) rate was 21.1% (8/38 patients): pN1 = 13.2% (n = 5), pN2 = 7.9% (n = 3). No pN3 cases were identified. Extranodal extension was detected pN (+) in 1/8 patients (12.5%). Mean node yield was 15.9 ± 2.3 nodes (13-23 nodes)/patient. Positive fine needle aspiration had a positive predictive value of 100%; fine needle aspiration is, however, a cytological confirmation test rather than an independent predictor. Lymphovascular invasion, perineural invasion, and G2/G3 grading showed non-significant trends toward pN (+) (p > 0.05). At data cut-off 30 June 2026, median follow-up was 32.5 months (range 1.3-47.0); mean disease-free survival was 25.6 months; recurrence rate was 15.8% (6/38). A non-significant trend toward longer disease-free survival was observed in the pN0 group (27.2 months) versus the pN (+) group (19.4 months). 10.5% patients received adjuvant chemotherapy.
Conclusion: VEIL provides accurate lymph node staging with a 21.1% pN (+) rate. Positive fine needle aspiration is the most predictive factor for nodal metastasis. Survival outcomes are acceptable with a mean disease-free survival of 25.6 months. Lymphovascular invasion, perineural invasion and G2/G3 grading showed non-significant trends toward pN (+).
Article Details
Keywords
Penile cancer, inguinal lymph node metastasis, VEIL, pN staging, survival outcomes, predictors.
References
[2] Brouwer O.R, Tagawa S.T, Albersen M et al. EAU-ASCO guidelines on penile cancer. European Association of Urology, 2026. https://uroweb.org/guidelines/penile-cancer
[3] Brouwer O.R, Clavell-Hernandez J, Huo J et al. Systematic review and individual patient data meta-analysis of studies comparing conventional and videoendoscopic inguinal lymph node dissection in penile cancer. Eur Urol Oncol, 2023, 6 (2): 168-177. doi: 10.1111/bju.16661
[4] Suartz C.V et al. Comparing open and video endoscopic lymphadenectomy for penile cancer: a systematic review and meta-analysis of prospective studies. BJU International, 2025, 135 (4): 567-576. doi: 10.1111/bju.16661
[5] Aydin A.M, Biben E, Yu A, Chakiryan N.H, Mehrazin R, Spiess P.E. Minimally invasive management of inguinal lymph nodes in penile cancer: recent progress and remaining challenges. Cancers (Basel), 2024, 16 (17): 2935. doi: 10.3390/cancers16172935.
[6] Brassetti A, Anceschi U, Cozzi G et al. Combined reporting of surgical quality and cancer control after surgical treatment for penile tumors with inguinal lymph node dissection: the tetrafecta achievement. Curr Oncol, 2023, 30 (2): 1882-1892. doi: 10.3390/curroncol30020146.
[7] Lee S.A, van der Poel H et al. High diagnostic accuracy of inguinal ultrasonography and fine-needle aspiration followed by dynamic sentinel lymph node biopsy in men with impalpable and palpable inguinal lymph nodes. BJU Int, 2022, 130 (1): 76-85. doi: 10.1111/bju.15700.
[8] Lohia N, Nazeer T, Chava S et al. Long-term oncological and surgical outcomes after video endoscopic inguinal lymphadenectomy (VEIL) in patients with penile cancer. Int Braz J Urol, 2023, 49 (5): 580-589. doi: 10.1590/S1677-5538.IBJU.2023.0065.
[9] Eskenazi F, Medina L.G, Soto Suarez R et al. Optimizing inguinal lymph node dissection for penile cancer: a pathway to improve outcomes and complications - a narrative review. Complications, 2025, 2 (3). doi: 10.3390/complications2030020