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LETTERS TO EDITOR
Year : 2022  |  Volume : 38  |  Issue : 3  |  Page : 241
 

Author reply Re: Kandasamy SG, Chandran KR, Pooleri GK. Minimal invasive approaches in lymph node management of carcinoma of penis: A review. Indian J Urol. 2022;38:15-21


Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Date of Submission25-Apr-2022
Date of Acceptance18-Jun-2022
Date of Web Publication1-Jul-2022

Correspondence Address:
Chandran Kosur Ravi
Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_133_22

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How to cite this article:
Kandasamy SG, Ravi CK, Pooleri GK. Author reply Re: Kandasamy SG, Chandran KR, Pooleri GK. Minimal invasive approaches in lymph node management of carcinoma of penis: A review. Indian J Urol. 2022;38:15-21. Indian J Urol 2022;38:241

How to cite this URL:
Kandasamy SG, Ravi CK, Pooleri GK. Author reply Re: Kandasamy SG, Chandran KR, Pooleri GK. Minimal invasive approaches in lymph node management of carcinoma of penis: A review. Indian J Urol. 2022;38:15-21. Indian J Urol [serial online] 2022 [cited 2022 Sep 30];38:241. Available from: https://www.indianjurol.com/text.asp?2022/38/3/241/349685




We are grateful to the readers for highlighting the important issues related to videoendoscopic inguinal lymphadenectomy (VEIL). The letter needs to be read as an adjunct to our article[1] as our concerns in the articles were highlighted by the authors of the letter.

  1. We agree that unnecessary violation of deep fascia for lymphadenectomy can be an overtreatment. In VEIL, the integrity of the skin is maintained and the dissection is limited to medial aspect of the femoral vessels, which can hypothetically reduce the chance of complication including lymphedema. It also gives a better sampling of lymph nodes and avoids a second surgery. The risk–benefit of the procedure needs to be assessed. As rightly mentioned in the letter, there is no comparative study between superficial lymphnode dissection and VEIL. Only focused studies addressing the issue can find an answer to the valid points raised in the letter
  2. The possibility of extracapsular spread increases with the size of the lymph nodes. We are skeptical about the role of VEIL in patients with larger lymph node burden where there is a possibility of extracapsular extension. Skin resection is needed if there is any fixity or suspicion of extracapsular spread, and in those cases, VEIL should not be attempted.


There is a lack of evidence about VEIL in a number of areas. Even though it is an exciting procedure, it needs to be used selectively and we accept all the concerns highlighted by the readers. It is more appropriate in clinically node negative or low volume lymph node disease where the chance of extracapsular extension is less. Since the complication rates are low with VEIL, the risks and benefits related to the possible overtreatment need to be studied in focused studies comparing the respective study populations.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.



 
   References Top

1.
Kandasamy SG, Chandran KR, Pooleri GK. Minimal invasive approaches in lymph node management of carcinoma of penis: A review. Indian J Urol. 2022;38(1):15-21  Back to cited text no. 1
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