Pd12-09 outcomes of 429 Primary Robotic Peritoneal Flap Gender Affirming Vaginoplasty Cases

Abstract

INTRODUCTION AND OBJECTIVE: Penoscrotal Paget's disease is a rare type of intraepithelial adenocarcinoma. Postsurgical reconstruction is a major challenge for surgeons. In this study, we evaluated the surgical outcomes after reconstruction surgery in patients with penoscrotal Paget's disease and proposed a novel strategy.METHODS: In this study, patients with penoscrotal Paget's disease who were referred to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between May 2004 and February 2021, were included. We proposed a three-step Perineal Reconstruction (PR) strategy to describe the location and extent of the defect and provide a reconstructive surgical method. Accordingly, all the postsurgical defects were reconstructed based on our strategy. The clinical data and outcomes during the follow-up were recorded and analyzed.RESULTS: Patients were 42e91 years old with a diagnostic delay of 2e201 months. Further, most patients had large defects, thin tumors, and erythematous plaques. All patients underwent frozen biopsy-guided wide local excision and lymph node biopsy or dissection. Further, 16 patients underwent re-excision with positive margins. According to the PR strategy, 54, 41, 58, and 80 of the patients underwent primary closure, skin grafting, flap coverage, or skin grafting combined with flap coverage, respectively. Three patients underwent multimodal treatment. The results showed no obvious difference between preoperative and postoperative sexual satisfaction. The follow-up time ranged from 9 to 210 months. Further, 3 patients died from metastasis and 10 patients died from other cancers, natural death, or other reasons.CONCLUSIONS: Wide local excision achieves a relatively low recurrence rate and preserves sexual function in patients with penoscrotal Paget's disease. The PR strategy is a promising method to assess defects and guide reconstruction.