Comparison of antegrade and retrograde laparoscopic bilateral inguinal lymphadenectomy for penile cancer

To investigate and compare the feasibility, safety, and clinical outcomes of antegrade and retrograde laparoscopic bilateral inguinal lymphadenectomy for penile cancer.

We retrospectively analyzed the clinical data of 32 patients with penile cancer admitted between 2018 and 2022. Among them, 17 patients underwent antegrade laparoscopic inguinal lymphadenectomy (ALIL group) and 15 underwent retrograde laparoscopic inguinal lymphadenectomy (RLIL group). The key surgical procedures and techniques are described. Operative time, intraoperative blood loss, hospital stay, drainage duration, postoperative complications, and follow-up data in both groups were statistically analyzed.

Surgery in both groups was successfully completed without the need for intraoperative conversion to open surgery. The operative time was significantly shorter for ALIL than for RLIL (P < 0.001). Significantly less intraoperative blood loss was reported with ALIL than with RLIL (P < 0.001). The ALIL group had a significantly shorter hospital stay than the RLIL group (P = 0.027). The number of removed lymph nodes in the ALIL group differed insignificantly from that in the RLIL group (P = 0.360). Postoperative drainage duration, recurrence, short-term survival, and postoperative complications were similar between both groups.

In the patients with penile cancer, ALIL and RLIL yielded similar perioperative outcomes. However, ALIL was associated with shorter operative time, less blood loss, and shorter hospital stays. ALIL did not require repositioning of the laparoscopic instruments, thereby simplifying the procedure and minimizing patient trauma. Additionally, if needed, pelvic lymphadenectomy could be performed simultaneously from the same trocar position used in ALIL.