MP61-16 INTRAOPERATIVE INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY IN INGUINAL WITH OR WITHOUT PELVIC LYMPH-NODE DISSECTION FOR PENILE SQUAMOUS CELL CARCINOMA (PeSCC)

You have accessJournal of UrologyPenile & Testicular Cancer II (MP61)1 May 2024MP61-16 INTRAOPERATIVE INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY IN INGUINAL WITH OR WITHOUT PELVIC LYMPH-NODE DISSECTION FOR PENILE SQUAMOUS CELL CARCINOMA (PeSCC) Carlo Silvani, Sebastiano Nazzani, Valentina Bernasconi, Martina Bruniera, Melanie Claps, Patrizia Giannatempo, Davide Biasoni, Tullio Torelli, Matteo Zimatore, Silvia Stagni, Alberto Macchi, Antonio Tesone, Emanuele Montanari, Mario Catanzaro, and Nicola Nicolai Carlo SilvaniCarlo Silvani , Sebastiano NazzaniSebastiano Nazzani , Valentina BernasconiValentina Bernasconi , Martina BrunieraMartina Bruniera , Melanie ClapsMelanie Claps , Patrizia GiannatempoPatrizia Giannatempo , Davide BiasoniDavide Biasoni , Tullio TorelliTullio Torelli , Matteo ZimatoreMatteo Zimatore , Silvia StagniSilvia Stagni , Alberto MacchiAlberto Macchi , Antonio TesoneAntonio Tesone , Emanuele MontanariEmanuele Montanari , Mario CatanzaroMario Catanzaro , and Nicola NicolaiNicola Nicolai View All Author Informationhttps://doi.org/10.1097/01.JU.0001009536.58867.87.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical inguinal lymph-node dissection (ILND) and inguino-pelvic lymph-node dissection (IPLND) for PeSCC associate with high complication rates. Specifically, wound complications affect up to 25% of patients treated with ILND. Intraoperative Indocyanine Green (ICG) Fluorescence Angiography has already been used in ILND for other malignancies to evaluate skin trophism to prevent skin necrosis with wound dehiscence. We aim to evaluate Intraoperative use of Indocyanine Green Fluorescence Angiography in PeSCC patients. METHODS: Since May 2023, we started a clinical trial focusing on any T cN1-cN3 cM0 peSCC patients planned for ILND or IPLND with or without concomitant penile surgery. IPLND were performed with a single vertical incision. Intraoperatively, before skin closure, ICG solution (25 mg of ICG dye in 10 ml of saline, 1 ml injected) was injected from a peripheral venous route. After 1 to 3 minutes the blood flow status of the skin flap was visible using an ICG fluorescence imaging camera. In cases where areas exhibited no fluorescence, we carefully trimmed the non-fluorescent sections of the skin flaps to prevent postoperative flap necrosis. RESULTS: We considered 12 patients for a total of 16 procedures. Specifically, 3 patients had unilateral ILND, and 2 patients had bilateral ILND. IPLND accounted for 56.25% of cases: 5 patients had unilateral and 2 had bilateral IPLND. Median age at diagnosis and median BMI were 67.5 years (57.5-69) and 30.23 (28.88-34.30), respectively. Four (33.3%) patients had diabetes and 5 (41.7%) ad an history of cardiovascular disease. Five (41.6%) were smokers or former smokers. Median number of retrieved inguinal and pelvic nodes for each side were 10 and 11, respectively. At definitive pathology 1 patients was pN1, 2 patients were pN2 and 6 patients were pN3. Out of pN3 cases, 4 had inguinal extra-nodal extension and 2 had pelvic nodal involvement. Median length of stay (LOS) was 5 days while median drainage tube stay time was 26 days. Out of 16 procedures, 8 postoperative complications were recorded: 3 (18.75%) were Clavien-Dindo IIIa (percutaneous lymphocele drainage of closed wound). Of note, the wound related complications were five (31.25%) but in as many as four it was a Clavien-Dindo I small wound dehiscence treated conservatively. One patient only (6.25%) suffered a complete wound dehiscence that required vacuum assisted closure placement (Clavien-Dindo II). Of note, no flap necrosis was observed. CONCLUSIONS: Wound management after ILND and IPLND for PeSCC remains challenging. Intraoperative use of ICG for skin flaps evaluation is promising. In our preliminary series, we observed an overall short LOS and a low rate of wound dehiscence. Greater numbers are needed to demonstrate that ICG could help in reducing wound dehiscence and LOS after nodal dissection in PeSCC patients. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1017 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlo Silvani More articles by this author Sebastiano Nazzani More articles by this author Valentina Bernasconi More articles by this author Martina Bruniera More articles by this author Melanie Claps More articles by this author Patrizia Giannatempo More articles by this author Davide Biasoni More articles by this author Tullio Torelli More articles by this author Matteo Zimatore More articles by this author Silvia Stagni More articles by this author Alberto Macchi More articles by this author Antonio Tesone More articles by this author Emanuele Montanari More articles by this author Mario Catanzaro More articles by this author Nicola Nicolai More articles by this author Expand All Advertisement PDF downloadLoading ...