Patient Success Story: Robotic Surgery for Penile Cancer and Inguinal Lymph Nodes in Lucknow

Penile Cancer Treated with Robotic Surgery in Lucknow

Penile cancer is an uncommon urological cancer, but when it occurs, early diagnosis and appropriate management of the groin lymph nodes are extremely important. The inguinal lymph nodes are usually the first regional lymph nodes to which penile cancer spreads, and lymph-node involvement has a major influence on subsequent treatment and prognosis.

At our Uro-Oncology unit at Chandan Hospital, Lucknow, we recently managed a patient with carcinoma of the penis who required surgical treatment of the inguinal lymph nodes.

The patient underwent bilateral robotic Video-Endoscopic Inguinal Lymphadenectomy (Robotic VEIL) as part of his comprehensive cancer treatment.

Why Are Lymph Nodes Important in Penile Cancer?

Penile cancer commonly follows a predictable pathway of lymphatic spread. Cancer cells may travel from the primary tumour to the inguinal lymph nodes located in the groin and, in more advanced cases, subsequently to the pelvic lymph nodes.

For this reason, treatment of penile cancer is not limited to treating the visible tumour on the penis. In selected patients, appropriate evaluation and treatment of the lymph nodes are equally important.

The decision to perform lymph-node surgery depends on several factors, including:

• Stage and grade of the primary penile tumour
• Histopathological features of the cancer
• Presence or absence of enlarged inguinal lymph nodes
• Imaging findings
• Overall risk of microscopic lymph-node metastasis

Appropriate lymph-node management can provide accurate staging and, in selected patients with regional disease, forms an important component of potentially curative treatment.

What Is Robotic VEIL?

VEIL stands for Video-Endoscopic Inguinal Lymphadenectomy.

Traditional inguinal lymph-node dissection requires relatively large incisions in the groin. These operations can be associated with wound-related complications because of the location and nature of the surgery.

Robotic VEIL allows the lymph-node dissection to be performed through small incisions using magnified three-dimensional vision and articulated robotic instruments.

The objective remains the same: an appropriate oncological lymph-node dissection. The difference is in the surgical access used to perform it.

In appropriately selected patients, a minimally invasive approach may offer advantages such as:

• Smaller surgical incisions
• Reduced wound morbidity
• Less postoperative discomfort
• Earlier mobilisation
• Faster postoperative recovery

Patient selection is important, and robotic VEIL is not necessarily the appropriate approach for every patient with penile cancer.

Our Patient's Treatment

Following complete evaluation and staging, the patient underwent:

Bilateral Robotic Video-Endoscopic Inguinal Lymphadenectomy (VEIL)

The procedure allowed systematic removal of the required inguinal lymph-node tissue on both sides using a minimally invasive robotic approach.

The patient subsequently had a satisfactory postoperative recovery and remains under regular oncological follow-up.

What Did the Final Histopathology Show?

The final pathological stage was:

pT2N1 Penile Cancer

Histopathological examination confirmed regional lymph-node metastasis, while the surgical margins were negative.

This information is particularly important because pathological assessment of the lymph nodes provides much more precise staging than clinical examination or imaging alone.

The final histopathology subsequently guides decisions regarding surveillance and whether any additional treatment needs to be considered.

Does Every Patient With Penile Cancer Need Lymph-Node Surgery?

No.

Management of the inguinal lymph nodes needs to be individualised according to the characteristics of the primary cancer and the clinical status of the lymph nodes.

Some patients with low-risk disease may be suitable for surveillance. Patients at greater risk of occult nodal metastasis may require invasive nodal staging, while patients with clinically involved lymph nodes may require therapeutic lymph-node treatment.

This is one reason why evaluation by a uro-oncologist experienced in penile cancer is valuable early in the treatment pathway.

Do Not Ignore a Persistent Penile Lesion

Penile cancer can initially appear as a relatively small lesion and may sometimes be mistaken for infection or another benign condition.

Medical evaluation should be considered for a persistent:

• Ulcer or non-healing wound on the penis
• Lump or growth
• Change in colour or thickness of the skin
• Bleeding lesion
• Persistent discharge
• Foreskin abnormality or difficulty retracting the foreskin
• Lump or swelling in the groin

Having one of these findings does not necessarily mean cancer, but a persistent abnormality should be examined rather than repeatedly treated without establishing a diagnosis.

Early and Specialised Treatment Matters

Penile cancer requires thoughtful management because treatment has two important objectives: achieving effective cancer control while preserving function and quality of life whenever oncologically appropriate.

Management may involve penile-preserving surgery, partial or radical surgery for the primary tumour, sentinel-node procedures, inguinal lymph-node dissection, chemotherapy, radiotherapy or combinations of these treatments depending on the stage of disease.

For patients who require inguinal lymph-node surgery, minimally invasive techniques such as robotic VEIL may be considered in carefully selected circumstances.

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About Dr. Anshuman Singh

Dr. Anshuman Singh is a fellowship-trained Uro-Oncologist and Robotic Surgeon in Lucknow, with a clinical practice focused specifically on cancers of the urinary and male reproductive systems.

He is currently Vice Chairperson & Unit Head – Uro-Oncology & Robotic Surgery at Chandan Hospital, Lucknow.

His advanced training in uro-oncology and robotic surgery includes:

• USI-Accredited Fellowship in Uro-Oncology & Robotic Surgery, Medanta – The Medicity, Gurugram
• Intuitive & Urological Society of India certification in robotic surgery
• Uro-oncology observership at Fundació Puigvert, Barcelona, Spain
• Clinical observership in Robotic Pelvic Oncology at University College London Hospitals (UCLH), London

His practice is dedicated to the evaluation and treatment of:

Prostate Cancer | Bladder Cancer | Kidney Cancer | Penile Cancer | Testicular Cancer | Upper Urinary Tract Cancer | Adrenal Tumours

with particular expertise in robotic surgery for urological cancers and complex uro-oncological procedures.

Through Uro-Onco Connect, the aim is to provide patients in Lucknow and the surrounding region access to specialised, evidence-based and individualised uro-oncology care.