Surgical Treatment of Penile Carcinoma: Our Experience from 1976 to 1997

Abstract

Objective: The purpose of this work is to evaluate our experience with the surgical treatment of penile squamous carcinoma, analyzing the therapeutic results in terms of local recurrence rates, survival and mortality rates. Material and Methods: From 1976 to 1997, 47 patients were treated at our institution for carcinoma of penis. Treatment of primary tumor was conservative in 8 patients (17%). Partial penectomy was performed in 30 patients (63.8%); total penectomy in 5 (10.7%) and emasculation in 4 (8.5%). Pathological stage was pTis in 2 cases (4.2%), pT1 in 20 (42.6%), pT2 in 21 (44.7%) and pT3 in 4 (8.5%). The tumor was clinically overstaged in 13 patients (27.7%) and understaged in 4 (8.5%). Bilateral inguinal lymphadenectomy was performed only in 4 patients clinically N+ (pN2) and in 3 clinically N0 (pN0). Results: Local recurrence rate was 43% in the patients with pT1 stage tumor treated conservatively. No local recurrence was observed after penectomy. 19 patients (40.4%) are alive and disease-free; 17 patients (36.2%) died of the tumor and 11 patients (23.4%) died of other causes but disease-free. Mean follow-up is 69.43 months. The overall 5-year survival rate was 34%. Conclusion: Partial penectomy gives better results than conservative treatment in the local management of the T1 stage tumor. Survival and mortality rates are related to both pathological and histological stages. The high mortality rate observed in the pT2 stage tumors in our experience might be related to the fact that in this stage an inguinal lymphadenectomy was not performed as a rule.

Cancer of the penis

“…Local recurrence, as high as 56%, more commonly occurs after organ-preserving procedures applied for T2 or T3 tumours [45,46].…”

A clinical, pathologic, and molecular study of p53 and murine double minute 2 in penile carcinogenesis and its relation to prognosis

“…Ficarra et al [8] reported an overall survival rate of 34% in 47 patients with penile cancer because systematic lymphadenectomy was not performed and because conservative treatment was not given in some stage T1 cases. In a previous study, we found that p53-negative patients had 5-and 10-year overall survival rates of 64.5% and 54.6%, versus 30.2% and 26.4% in p53-positive patients, respectively-a statistically significant difference by univariate analysis [9].…”

“…In addition, p53 translated from a mutant gene has a longer halflife, in opposition to the wild-type protein. Because both share epitopes, the mutated protein can be detectable by immunohistochemistry (IHC) [7,8]. Lopes et al [9] correlated the overexpression of p53 protein with an unfavorable prognosis in PC.…”

The Role of Radiation Therapy after Incomplete Resection of Penile Cancer

“…Other factors that are associated with penile squamous cell carcinoma include cigarette smoking, physical inactivity, and other infections of the penis, whereas a protective role of neonatal circumcision has been suggested [37]. Total or partial penectomy is, traditionally, the standard therapy of penile carcinoma and local control rates of > 90% can be achieved [12,25]. However, its significant effects on quality of life have led to the development of several organ-preserving techniques [1,5,18,30].…”

“…To avoid an unacceptable local recurrence rate, a 1.5-2 cm margin of resection is necessary and, traditionally, the standard treatment of penile cancer. Partial or total penectomy guarantees excellent local control rates [12]. However, radical surgical treatment strategies have been associated with significant impairment of sexual function and quality of life [25].…”