Elsevier

European Urology

Volume 52, Issue 4, October 2007, Pages 1179-1185
European Urology

Penile Cancer
Reconstructive Surgery for Invasive Squamous Carcinoma of the Glans Penis

https://doi.org/10.1016/j.eururo.2007.02.038Get rights and content

Abstract

Objectives

We present medium-term outcome data for patients with invasive penile cancer treated with glansectomy and reconstruction with a split-thickness skin graft.

Methods

A series of consecutive patients referred with penile malignancies over a 6-yr period were analyzed prospectively. A dedicated histopathologist reviewed all the specimens. After clinical staging, patients with tumours confined to the glans were offered glansectomy.

Results

A total of 72 patients (32% of patients, 31% of procedures) underwent glansectomy for penile carcinoma. Of these, 65 patients were new diagnoses and seven were recurrences after radiotherapy. The mean follow-up period was 27 mo (range: 4–68 mo). There have been three late local recurrences (4%).

Conclusion

Glansectomy appears to be an oncologically safe and effective procedure for patients with glans-confined squamous cell tumours. It preserves maximum phallic length and results in a very satisfactory cosmetic penile appearance after reconstruction.

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.

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