MP33-12: Comparing perioperative outcomes after robot assisted video endoscopic inguinal lymphadenectomy (RAVEIL) with open inguinal lymph node dissection (O-ILND) using propensity score match analysis
Introduction: Since the advent of robot, the indications for performing robot assisted surgery in urology have been expanding. Although open inguinal lymph node dissection (O-ILND) still remains the gold standard for management of inguinal lymph nodes in carcinoma of penis, the post-operative complications, time to drain removal and lymphocoele formation remain a drawback even in high volume centers. In this study, we intend to compare these perioperative parameters of (O-ILND) with RAVEIL using propensity score match analysis (PSM). Methods: This study is retrospectively analyzed from a prospectively maintained cancer registry of the oncology department in our tertiary care institute. The data was obtained between 2008 and July 2022 from a single center operated by a single surgeon to avoid surgeon and institution bias. Patients with incomplete data set and no follow up for at least 3 post-operative months were excluded from the study. Univariate analysis was performed for baseline parameters, pathologic and perioperative outcomes among the two groups using Chi square test for categorical variables and student t-test was used for continuous variables. Multivariate logistic regression analysis was then performed. Propensity score match analysis (PSM) 1:1 was used to independently evaluate postoperative complications of Clavien dindo grade 3 and above and time to drain removal and skin complications after matching for the patient and pathologic characteristics. The value of p considered significant was <0.05. Statistical analysis were performed using SPSS version 23 and propensity score match analysis was performed using XLSTAT. Results: Among 86 patients, 154 inguinal node dissections (68 O-ILND and 86 RAVEIL) were performed. Median age of patient was 60 (IQR 54-62) in O-ILND and 58 (IQR 56-61) in RAVEIL. Most common tumor stage for both arms was T2 (68.2 % in O-ILND vs 71% in RAVEIL) and most common grade was poorly differentiated (56.2 % in O-ILND vs 48.6% in RAVEIL). The operative time among both groups was comparable (100 minutes in O-ILND vs 92 minutes in RAVEIL) Perioperative factors significantly improved among RAVEIL group was preservation of saphenous vein, Clavien Dindo complications 3 or more and skin complications. PSM 1:1 done for 64 inguinal node dissections matched for baseline patient and pathologic variables found Clavien Dindo complications 3 or more and skin complications to be significantly lesser in the RAVEIL group. Conclusions: Although few previous studies in recent years have already mentioned the non-inferior oncologic outcomes and lesser morbidity with RAVEIL, this study is the first to our knowledge which uses PSM to match patient and tumor characteristics and thereby identify specific benefits of RAVEIL statistically. This study can also be used as a platform for a larger multi centric evaluation prospective analysis and thereby broaden the application of RAVEIL in near future. SOURCE OF Funding: We have no source of funding
