Oncologic outcomes and subsequent treatment following organ sparing surgery for penile carcinoma: The University of Texas M.D. Anderson Cancer Center Experience

5•Organ sparing surgery with negative margins provides excellent local control for penile cancer and was performed 38% of patients undergoing penile cancer surgery at our institution.5•Most local recurrences were successfully managed with further organ preservation.5•Long term follow up is essential...

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Published in:Urologic oncology 2021-05, Vol.39 (5), p.302.e19-302.e27
Main Authors: Kokorovic, Andrea, Duplisea, Jonathan, Qiao, Wei, McCormick, Barrett, Adibi, Mehrad, Papadopoulos, John, Ramirez, Gabriela, Rao, Priya, Tamboli, Pheroze, Pettaway, Curtis
Format: Article
Language:English
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Summary:5•Organ sparing surgery with negative margins provides excellent local control for penile cancer and was performed 38% of patients undergoing penile cancer surgery at our institution.5•Most local recurrences were successfully managed with further organ preservation.5•Long term follow up is essential to detect recurrences beyond 5 years.5•Laser therapy for invasive tumors was associated with higher rates of local recurrence. To determine the oncologic outcomes of organ sparing surgery (OSS) for penile cancer and to determine the management of and risk factors for local recurrence at a tertiary referral center in the United States. Patients undergoing OSS from 1996 to 2018 at The University of Texas, MD Anderson Cancer Center were identified using a prospective database. Organ sparing procedures included: wide local excision (WLE; including circumcision and glans resurfacing), partial or total glansectomy, laser therapy, or OSS combined with laser ablation (i.e., laser combination). Clinical and pathologic data were collected for descriptive analysis. Recurrences (local and regional) were identified, and the association between overall and local recurrences was determined using Cox proportional hazards regression. Overall and recurrence free survival analyses were performed using Kaplan-Meier estimates. A total of 129 patients undergoing OSS were identified with a median follow up interval of 28.0 months. The most common OSS was laser combination (38.8%), and 65.1% of patients presented with pTis or ≤pT1a disease. Twenty (15.5%) recurrences were identified, of which 17 (13.2%) were local and 3 (2.3%) were regional. There were no distant recurrences as the initial site of recurrence. The median time to local recurrence was 20.9 months, and 88.2% were identified within 5 years of surgery. Most (76.5%) local recurrences were successfully treated with further penile preservation without a detrimental impact on overall survival. Patients with pathologic Ta or T1a disease treated with laser or laser combination surgery were more likely to present with local recurrence. OSS using a variety of techniques to achieve negative surgical margins provides long-term effective local control for localized penile cancer. Most local recurrences can be successfully treated with further penile preserving strategies and long follow-up is essential. Laser therapy or laser combination with OSS should be used with caution in patients with invasive penile cancer.
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2021.02.004