Penile CancerReconstructive Surgery for Invasive Squamous Carcinoma of the Glans Penis
Introduction
Penile cancer is a rare malignancy in Western countries, with an incidence of less than one in 100,000. In the United Kingdom there are around 360 new cases per year, and the development of supraregional networks has meant that these patients are now being managed in a few specialist centres. This has enabled urologists and oncologists in the United Kingdom to develop and evaluate new treatments in a way that has not previously been possible [1].
Until recently, partial or radical penectomy was the mainstay of surgical treatment for penile cancer, but this is associated with considerable psychosexual morbidity [2]. These operations were based on the understanding that a 2-cm macroscopic margin is necessary for adequate oncological control. Recent evidence, however, has suggested that margins of only a few millimetres may be adequate for most tumours, which has led to increasing interest in penile-preserving procedures [3], [4]. Current EAU guidelines on the management of penile cancer strongly recommend a penile-preserving approach for patients with Ta–T1 G1–G2 tumours who can commit to a regular surveillance programme, and the guidelines suggest that it may also be an option in very selected patients with T1 G3 and T < 2 disease whose tumours occupy less than 50% of the glans. Alternative recommended procedures include laser, local excision with reconstruction, and brachytherapy [5].
In a previous paper we reported early outcome data for invasive penile cancer treated with a variety of penile-preserving techniques, including partial glansectomy with or without reconstruction, glansectomy with reconstruction, and glansectomy and distal corporectomy with reconstruction [6]. Here we present medium-term data for the largest group of patients, those with tumours confined to the glans who have been treated with glansectomy.
Section snippets
Methods
We prospectively analyzed consecutive patients with invasive penile cancer treated with glansectomy over a 6-yr period. Patients were referred from a supraregional network. All cases were reviewed in a specialist multidisciplinary team meeting by a single histopathologist and staged according to the revised 2002 American Joint Committee on cancer TNM staging system.
Patients who were assessed to have squamous cell tumours limited to the glans (ie, T1 and T2 tumours of the corpus spongiosus) on
Results
Of the 245 patients referred to our unit for the management of penile cancer, 222 patients required penile surgery. Of these, 178 patients had tumours that were at least T1, and the procedures performed are listed in Table 1. Seventy-two patients (32% of patients, 31% of procedures) were treated with glansectomy and skin graft reconstruction for penile squamous cell carcinoma, which comprises the largest group. The mean age was 60 yr (range: 27–87 yr). Seventeen (24%) had grade 1 tumours, 31
Discussion
In 2001 a questionnaire survey was completed by 289 urologists and 237 oncologists in the United Kingdom to assess their management of localized penile cancer; the study found that almost 30% of urologists and one oncologist preferred partial or total amputation for even a small distal lesion on the glans penis [7]. However, 80% of penile carcinomas involve the glans, coronal sulcus, or prepuce and may therefore be amenable to penile-preserving rather than amputative surgery. Another U.K. study
Conclusion
As our understanding of penile cancer increases, it is becoming increasingly apparent that the traditionally advocated resection margin has resulted in over treatment of many patients. With close postoperative observation, glansectomy is an ideal treatment for patients with T1 and T2 penile carcinoma confined to the corpus spongiosus. Glansectomy allows preservation of penile length and satisfactory cosmetic appearance, without compromising local cancer control. Although longer follow-up is
Conflicts of interest
The authors have nothing to disclose.
Acknowledgements
We thank Aivar Bracka, who originally described the technique to the senior author.
References (21)
- et al.
EAU guidelines on penile cancer
Eur Urol
(2004) - et al.
External-beam radiotherapy in T1–2 N0 penile carcinoma
Clin Oncol (R Coll Radiol)
(2006) - et al.
Interstitial brachytherapy for penile cancer: an alternative to amputation
J Urol
(2002) - et al.
Laser microsurgery for superficial lesions of the penis
J Urol
(1987) - et al.
Combined laser treatment for penile carcinoma: results after long-term follow up
J Urol
(2003) - et al.
Multi-institutional long-term experience with conservative surgery for invasive penile carcinoma
J Urol
(2003) - et al.
Intraoperative frozen section diagnosis in urological oncology
Eur Urol
(2005) - et al.
Conservative surgical therapy for penile and urethral carcinoma
Urology
(1999) - et al.
Glansectomy: an alternative surgical treatment for Buschke-Löwenstein tumors of the penis
Urology
(2001) - et al.
Dynamic sentinel node biopsy in penile carcinoma: an evaluation of 10 years experience
Eur Urol
(2005)
Cited by (105)
Advances in penile-sparing surgical approaches
2022, Asian Journal of UrologyGlansectomy and Reconstruction for Penile Cancer: A Systematic Review
2022, European Urology FocusThe Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Invasive Penile Cancer Confined to Glans
2022, UrologyCitation Excerpt :When performing GS, significant intraoperative complications are very uncommon. The established data regarding complications mirrors our results.13,24,25,29-30 However, GS does present an incidence of minor postoperative complications, most frequently are graft loss (partial), and urethral neo-meatus stenosis.
What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes
2022, European Urology Open ScienceCitation Excerpt :All 16 NRCSs were retrospective studies, 12 comparing penile-sparing surgery with amputative surgery [11–17,20–22,24,25] and four comparing radiotherapy with penile surgery [10,18,19,23]. All 72 CSs were retrospective, with 39 studies addressing penile surgery [6,7,56–92], 20 reporting on radiotherapy [26–45], ten reporting on lasers [46–55], and three reporting on Moh’s micrographic surgery [93–95]. All NRCSs were assessed to have a high RoB (summarized in Fig. 2).
Update on organ preserving surgical strategies for penile cancer
2022, Urologic Oncology: Seminars and Original InvestigationsCentralization and Equitable Care in Rare Urogenital Malignancies: The Case for Penile Cancer
2021, European Urology Focus