Introduction:

Inguinal lymph node dissection (ILND) is the standard of care for high risk localized and radiographically evident inguinal node positive penile cancer. Although this cancer is potentially curable with radical inguinal surgery, ILND has a very high incidence of morbidity. Here we compare a single surgeon’s postoperative outcomes after ILND at a high-volume North American center for penile cancer with respect to early postoperative clinic visits facilitated by virtual telemedicine.

Methods:

We retrospectively collected data on patients undergoing ILNDs performed by a single surgeon from August 2006 to April 2024 including post operative complications, readmission rates/emergency room visits, and post discharge patient calls/portal messages.

Cohort 1 included patients with clinic visits at or greater than 14 days after discharge. Cohort 2 was defined as telemedicine or in person clinic visits scheduled within 1 week post discharge, with patients seen within 10 days of discharge to account for logistical issue with scheduling. Medically prompted or patient initiated early telemedicine or clinic visits were excluded.

We defined standard ILND as unilateral or bilateral superficial +/- deep templates, +/- sartorius myocutaneous rotational flaps. Complex ILND surgeries were defined as unilateral or bilateral ILND with pelvic lymph node dissection +/- complex wound closures such as rectus abdominus rotational flaps.

Categorical and continuous variables were evaluated for significance using chi-squared/Fisher exact and Wilcoxon rank-sum tests, respectively.

Results:

Cohort 1 included 63 patients and Cohort 2 included 32 patients. Baseline patient demographics and clinicopathological features were similar and statistically insignificant between the two cohorts (table 1).

10/32 (31.3%) patients in cohort 2 had an early post of visit facilitated by virtual telemedicine. 15/32 (46.9%) patients underwent a clinically meaningful intervention within the early post op phase.  The most common post op complications were wound infection, surgical site fluid collections, and lymphedema (figure 1).

Cohort 2 showed a statistically significant reduction in overall 30-day Clavien scores (p=0.026), even after accounting for confounders (table 2 & figure 2), with more statistical significance when accounting for only Clavien grade 1-2 (p = 0.016). Cohort 2 showed a statistically significant reduction in postop hospital readmission/ED visits (chi-squared p=0.0382), however, logistic regression analysis accounting for confounders showed a close but statistically insignificant association. Post-op patient calls showed no significance between cohorts (table 2).

Conclusion:

We present data from a high-volume ILND center, delineating a standardized change in earlier post op follow-up. Our data showed a statistically significant reduction in post op Clavien scores within Cohort 2. Although it could be surmised that this Cohort included more recent patients and improvement in surgeon experience could account for better post op outcomes, we note that early post of visits allowed for clinically meaningful interventions in almost 50% of these patients including early post-op drain removals, early imaging to evaluate for fluid collection, escalation in antibiotics for wound infection, wound care therapy and education. Although reduction in post of ED visits/readmissions were not statistically significant after accounting for confounders, early post op visits allowed earlier identification of incipient complications and allowed for early outpatient interventions without the need of hospitalization. Telemedicine can easily facilitate an early check in point for patients undergoing an already very morbid surgery.

Funding: N/A