Abstract
OBJECTIVE: To assess the feasibility and safety of suprapubic incision antegrade endoscopic inguinal lymphadenectomy with preservation of the great saphenous vein and its branches in penile cancer treatment. METHODS: Between February 2023 and July 2024, penile cancer patients undergoing suprapubic incision endoscopic inguinal lymphadenectomy with great saphenous vein and branch preservation were recruited from the Urology Departments of Huai'an First Hospital Affiliated to Nanjing Medical University and Xuzhou Cancer Hospital. Fifteen patients (mean age: 67.4 ± 8.85 years) were included, all having undergone partial penectomy. Postoperative pathology confirmed tumor stages ≥ T1b, and no distant metastasis was observed. In the supine position, a subcutaneous space was created under direct vision, followed by establishment of endoscopic working channels. Dissection encompassed superficial and deep inguinal lymph nodes while preserving the great saphenous vein trunk and branches. Anatomical boundaries were defined as: upper border-line between external ring upper edge and anterior superior iliac spine; outer border-line from anterior superior iliac spine to 20 cm inferior; inner border-medial thigh from pubic tubercle to 15 cm inferior; lower border-line connecting lower edges of inner and outer boundaries. RESULTS: All patients underwent successful bilateral inguinal lymphadenectomy. Mean operation duration was 96 ± 18.8 min, with mean blood loss of 41.3 ± 16.2 ml. Average lymph node yields were 7.3 ± 3.9 (left) and 9.5 ± 4.4 (right). Drainage tubes were indwelling for 7.7 ± 2.0 days, with total drainage volume of 274.7 ± 126.4 ml, and mean hospital stay was 8.7 ± 1.8 days. All wounds achieved grade A healing. Postoperative complications included 1 lymphocele and 1 lymphorrhea, both resolved with symptomatic management. During 9-25 months of follow-up, no cases of wound infection, subcutaneous hematoma, lower limb edema, skin necrosis, or local/distant metastasis were observed. CONCLUSIONS: Suprapubic incision antegrade endoscopic inguinal lymphadenectomy with great saphenous vein and branch preservation exhibits definite therapeutic efficacy and minimal complications, justifying cautious clinical implementation.