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Project international Delphi consensus recommendations for perioperative management of inguinal lymphadenectomy in
Nahuel Paesano1, Luis G Medina2, Marcos Tobias-Machado3
1Department of Urology, ROC Clinic - HM Hospitals, Madrid, Spain.
Objective:
To establish international expert consensus on perioperative strategies for the prevention, management, and follow-up of complications related to inguinal lymph node dissection.
Methods:
This international modified Delphi consensus study was conducted between September 2025 and March 2026 using a 2-round electronic survey. A total of 101 experts from 25 countries participated, including urologists, surgical oncologists, plastic surgeons, and other specialists with experience in ILND for penile cancer, melanoma, and vulvar cancer. Eighty-six clinical statements addressing ILND-associated complications were evaluated across 6 domains: preoperative nutritional optimization, anemia management, lymphatic complications, infectious and cutaneous complications, vascular and musculoskeletal complications, and functional rehabilitation. Agreement was assessed using a 5-point Likert scale, with consensus defined a priori as at least 70% of participants selecting "somewhat agree" or "strongly agree."
Results:
Consensus was achieved for 51 of 86 statements. Agreed recommendations supported standardized approaches to preoperative nutritional assessment and anemia correction, prevention and management of lymphatic complications, drain placement and management, discharge criteria, antibiotic prophylaxis, wound complication management, thromboprophylaxis, multimodal analgesia, and early functional rehabilitation. No consensus was reached regarding routine use of immunonutrition, optimal duration of antibiotic therapy, topical treatments, muscle relaxants, or hyperbaric oxygen therapy.
Conclusions:
This international Delphi process generated consensus-based, multidisciplinary recommendations to guide perioperative ILND management. These statements may provide a structured framework to support greater standardization of perioperative care pathways across malignancies requiring ILND, reduce morbidity, and inform quality-improvement initiatives. Prospective validation is required to evaluate their clinical impact and refine areas of ongoing uncertainty.
