Organ-Preserving Surgery for Penile Carcinoma

Abstract

Introduction. Penile carcinoma has traditionally been treated by either surgical amputation or radical radiotherapy, both associated with devastating anatomical, functional, and psychological impact on the patient's life. Innovative surgical techniques have focused on penile preservation in well-selected patients to minimize physical disfigurement and consequently maximize quality of life. The objective of this article is to define the current status of these organ-preserving surgical options for penile carcinoma. Materials and Methods. An extensive review of the Pubmed literature was performed to find articles discussing only reconstructive surgery which have contributed significantly to change traditional, frequently mutilating treatments, to develop less disfiguring surgery, and to improve patients' quality of life over the last two decades. Results. Several articles were included in this analysis in which a major contribution to the change in therapy was thought to have occurred and was documented as beneficial. Some articles reported novel techniques of less-mutilating surgery involving different forms of glans reconstruction with the use of flaps or grafts. The issue of safe surgical margins was also addressed. Conclusion. The development of less-disfiguring techniques allowing phallus preservation has reduced the negative impact on functional and cosmetic outcomes of amputation without sacrificing oncological objectives in appropriately selected patients based on stage, grade, and location of the tumour. Until more prospective studies are available and solid evidence is documented, organ preservation should be offered with caution.

Synchronous Double Primary Cancer of the Penisand Urinary Bladder

“…In general surgery with curative intent is advised if possibility of a R0 resection is there. Organ preservation is of utmost importance in penile cancer so as to provide a better quality of life to the patient along with minimal morbidity, especially when a favorable histology (stages Tis, Ta, T1; grades 1 and 2) is present as they are at a low risk for local progression and distant metastatic spread [14]. In our case partial penectomy and TURBT proved to be sufficient [15].…”

Reconstrucción del glande con injerto cutáneo libre según técnica de Bracka

“…Entre ellos está el tratamiento tópico con 5-fluorouracilo y pomada de imiquimod, la radioterapia externa o intersticial, la ablación con láser y la criocirugía 5,6 . Así mismo, la exéresis tumoral controlada bajo supervisión microscópica extirpando el tumor en capas sucesivas (cirugía de Mohs) o la ablación con láser (dióxido de carbono, argón, Nd:YAG o KTP) o la propia circuncisión para los tumores de bajo estadio y grado alojados en el prepucio, son también técnicas quirúrgicas conservadoras que pueden emplearse con tasa variable de recidiva.…”

“…There was no local recurrence. 6 Patients returned to normal sexual activity after complete healing. Conclusions: There is a significant number of patients with penile cancer and/or other penile skin pathologies who can undergo definitive and non-mutilating surgery with excellent oncologic, cosmetic and functional results with skin grafting.…”

Organ Preservation Surgery for Carcinoma Penis

“…Good cosmetic and functional outcome are obtained using laser. Francisco E et al [12] in their review mention that though laser has significant anatomical, cosmetic, and functional advantages over traditional amputation, a close surveillance is mandatory for early detection of local recurrence, which is higher. Hence, patient selection is extremely important.…”

“…About 80% of the penile carcinomas arise distally, which render them potential candidates for penile-preserving surgery (12). Glansectomy can be done either partially or totally for dealing with local excision of distal tumors on the glans and prepuce (32)(33)(34)(35).…”