Inguinal lymph node dissection (ILND) remains a cornerstone of nodal management in penile cancer, providing definitive treatment for clinically node-positive disease and surgical staging for high-risk clinically node-negative patients when dynamic sentinel node biopsy (DSNB) is unavailable. Despite its oncological importance, ILND is associated with substantial morbidity. Over the past decade, minimally invasive (MI) approaches have emerged as alternatives to open ILND, with the potential to reduce wound-related complications while maintaining oncological efficacy. This Surgery in Motion article provides a practical overview of contemporary open, video-endoscopic (VEIL), and robot-assisted (RAVEIL) ILND techniques, integrating anatomical principles, technical variations, and current clinical evidence. Open ILND remains the reference approach, particularly in patients with advanced nodal disease, while MI techniques may be considered in selected patients with limited nodal disease at experienced centres. Across all approaches, meticulous adherence to anatomical templates, appropriate patient selection, and preservation of lymphatic and vascular structures where oncologically feasible are key principles for minimising morbidity. Emerging robotic and image-guided technologies may further refine ILND, although their clinical benefits and long-term oncological outcomes require further evaluation. This stepwise educational review and accompanying surgical video aim to support surgical training, standardisation, and safe implementation of contemporary ILND techniques.

The phase 2 randomized LUNAR trial previously demonstrated that neoadjuvant [177]Lu-PNT2002 before stereotactic body radiotherapy (SBRT) significantly improved progression-free survival (PFS) in patients with oligorecurrent hormone-sensitive prostate cancer (orHSPC). We report updated efficacy and safety outcomes with extended follow-up. Patients with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-detected orHSPC and one to five metastatic lesions amenable to SBRT were randomized 1:1 to SBRT alone or two cycles of neoadjuvant [177]Lu-PNT2002 followed by SBRT. The primary end point was PFS, defined as new lesions on PSMA PET/CT, initiation of salvage hormonal therapy, or death. Secondary end points included hormonal therapy-free survival (HT-FS) and 24-mo progression-free status. Exploratory end points included polymetastatic PFS (poly-PFS), castration-resistant disease-free survival (CRFS), and conventional imaging progression-free survival (CT-PFS). Between September 2022 and November 2023, 92 patients were randomized to SBRT alone (n = 47) or [177]Lu-PNT2002 plus SBRT (n = 45). At a median follow-up of 31.9 mo, [177]Lu-PNT2002 significantly improved PFS (median 17.6 vs 7.4 mo; hazard ratio [HR] 0.38, 95% confidence interval [CI] = 0.23-0.61; p < 0.001) and HT-FS (HR 0.57, 95% CI = 0.34-0.95; p = 0.03). Exploratory analyses demonstrated improved poly-PFS (HR 0.28, 95% CI = 0.08-1.03; p = 0.04), CRFS (HR 0.13, 95% CI = 0.02-1.10; p = 0.03), and CT-PFS (HR 0.46, 95% CI = 0.19-1.09; p = 0.07). No new safety signals were observed. With extended follow-up, neoadjuvant [177]Lu-PNT2002 before SBRT produced durable improvements in PFS and HT-FS. While poly-PFS, CRFS, and CT-PFS were exploratory end points, their improvement provides hypothesis-generating evidence that the addition of radioligand therapy to SBRT may alter disease trajectory beyond delaying PSMA PET/CT-detected recurrence.