Locally advanced penile carcinoma: classic emasculation or testis-sparing surgery?

Abstract

Purpose:The study evaluates the clinical and pathological fi ndings of 16 patients with locally advanced penile carcinoma (PC) submitted to emasculation, and discusses questions related to the usefulness of bilateral orchiectomy. Materials and Methods: Between 1999 and 2010, 172 patients with PC were treated. Sixteen (9%) underwent emasculation. Data were retrieved from the institution's database including age, ethnicity, date of surgery, residential setting, level of schooling, time to diagnosis, type of reconstruction, complications, tumor stage and grade, vascular and perineural invasion along with invasion of corpus cavernosum, corpus spongiosum, testicles, scrotum and urethra. Results: A total of 16 patients (average: 63.1 years) with locally advanced PC were included. All were illiterate or semiliterate rural dwellers and 87% were white. The time to diagnosis was 8-12 months. The mean follow-up time was 31.9 months (1-119). By the time of the last follow-up, only seven patients (43.75%) were alive. Tumors were pT4 (n = 6), pT3 (n = 8), pT2 (n = 2), Grade I (n = 5) and Grade II (n = 11). The histopathological examination revealed invasion of the urethra (n = 13), scrotum (n = 5) and testicles (n = 1). The surgical margin was positive in one patient. Six patients (37.5%) had vascular invasion and 11 (68.7%) had perineural invasion. Currently, only one of the former is alive. Conclusions: The fi nding of focal microscopic testicular infi ltration in only one of 32 testicles, even in the presence of clinically apparent scrotal invasion, suggests that emasculation without bilateral orchiectomy is a safe treatment option for patients with locally advanced PC.

The role of perineural invasion in penile cancer: a meta-analysis and systematic review

“…A total of 1001 PC patients, 298 patients present with PNI, were identified in current meta-analysis and systematic review for a future evaluation [ 5 , 6 , 14 , 17–21 , 25–28 ]. In addition to SCC patients, there were 41 cases with EMPD eligible for analysis.…”

“…In these 12 included studies, PC patients came from America [ 19 ], U.K. [ 28 ], Australia [ 5 ], China [ 18 , 26 ], Brazil [ 14 , 17 , 19 , 21 ], and Paraguay [ 14 , 19 ]. In addition, the detailed characteristics of enrolled studies were summarized in Table 1 [ 5 , 6 , 14 , 17–21 , 25–28 ]. The association between PNI and ILNM was reported by eight studies [ 5 , 14 , 17–21 ], but one study was excluded from this meta-analysis because of limited data [ 6 ].…”

“…In addition, the detailed characteristics of enrolled studies were summarized in Table 1 [ 5 , 6 , 14 , 17–21 , 25–28 ]. The association between PNI and ILNM was reported by eight studies [ 5 , 14 , 17–21 ], but one study was excluded from this meta-analysis because of limited data [ 6 ]. Another two studies evaluated the role of PNI in cancer-specific survival (CSS) and cancer-specific mortality (CSM) of patients, listing HR and its 95% CI in multivariable Cox regression, respectively.…”

“…Nevertheless, PNI still is a controversial predictor in PC patients. Several studies indicated that PC patients with PNI carried a higher risk of ILNM [ 14 , 17–19 ]. On the contrary, several researchers took an opposite opinion [ 5 , 20 , 21 ].…”

Experiência do Hospital Haroldo Juaçaba com Reconstrução Utilizando Retalhos Miocutâneos em Cirurgia para Tratamento do Câncer de Pênis locorregionalmente Avançado

“…no Hospital Haroldo Juaçaba, pacientes com neoplasia peniana que apresentam invasão proximal do corpo cavernoso e acometimento da pele do saco escrotal são submetidos rotineiramente à emasculação que inclui penectomia total, ressecção do saco escrotal e orquiectomia bilateral. um trabalho que avaliou 16 pacientes submetidos a esse procedimento, em um período de dez anos, mostrou que a emasculação sem orquiectomia bilateral pode ser uma opção de tratamento segura, uma vez que apenas um dos 32 testículos clínicamente acometidos tinham infiltração focal microscópica do testículo 6 . a linfadenectomia inguinal deve ser realizada em pacientes cn0 quando eles são considerados de alto risco para metástase oculta, ou seja, aqueles com tumores t2, G3, ou evidência de invasão linfovascular 7 .…”