Robot- Assisted Video Endoscopic Inguinal Lymph node Dissection for Penile Cancer : A Indian Multicentre Experience.

OBJECTIVE:To report outcomes of multicentre series of penile cancer patients undergoing Robot Assisted Video Endoscopic Inguinal Lymph Node dissection(RA-VEIL ) . MATERIAL AND METHODS:In this retrospective analysis from 3 tertiary care centres in India , consecutive intermediate /high risk carcinoma penis(CaP) patients with non-palpable inguinal lymphadenopathy and /or non-bulky (<3cm ) mobile inguinal lymphadenopathy undergoing RA-VEIL were included . Patients with matted/ bulky (> 3cm ) and fixed lymphadenopathy were excluded . Demographic, clinical and intraoperative data were recorded. Perioperative complications were graded by Clavien Dindo classification(CDC). The International Society of lymphology(ISL){0-III} grading was used for assessment of lymphedema . Incidence and pattern of recurrences was assessed on follow up . RESULTS:From 1st January 2011 to 30th September 2023 , 115 patients(230 groins) underwent bilateral RA-VEIL for carcinoma penis(CaP) . The median age of the cohort was 60(50-69) years . Clinically palpable (either unilateral or bilateral) inguinal lymphadenopathy was seen in 54 patients (47%). The "per groin "median operative time was 120 (100-140) minutes with median lymph node yield of 12(9-16). No complications were recorded in 87.8 % groins operated with major complications (CDC 3) seen in 2.6 % groins. At a median follow up of 13.5 months, 13 patients had documented recurrences and there were 10 cancer related deaths. No port site recurrences were observed. No/Minimal lymphedema (ISL 0/I) was seen in 94 % legs. CONCLUSION:RA-VEIL demonstrates safety and oncological efficacy in penile cancer patients presenting with clinically non-palpable and/or non-bulky inguinal lymphadenopathy, with favourable functional outcomes.