In a study assessing the association between local recurrence rates and surgical resection margins among 332 patients undergoing organ-preserving surgery, Sri et al. found that 64% of the patients had a <5 mm clear deep surgical margin, with 16% clear by <1 mm.1 Additionally, these authors found an increased risk of local recurrence in the clear margin cohort of <1 mm compared to those of >1 mm (p < 0.001).
Dr. Protzel favors treatment of the primary tumor by a stage-based approach. For patients with carcinoma in situ, Bowen’s disease, or erythroplasia de Queyrat, treatment options include laser ablation with CO2 or Nd:YAG laser ablation. For patients with Ta or T1a (grade 1-2), treatment options include wide local excision with circumcision, CO2 or Nd:YAG laser ablation, glans resurfacing, or glansectomy with reconstructive surgery with or without skin grafting. Among patients with T1b (grade 3) or T2 tumors, treatment options include wide local excision plus reconstructive surgery, with or without skin grafting, or a glansectomy with circumcision and reconstruction. Patients with T3 disease confined to the distal aspect of the penis may be eligible for a glansectomy with resection of the infiltrated part of the corpora +/- reconstruction with skin grafting. Finally, patients with T3 or T4 disease should have a partial penectomy or total penectomy with a perineal urethrostomy, in addition to a potential role of neoadjuvant chemotherapy in this disease space.
Dr. Protzel concluded his presentation with the following take-home messages:
- Organ-preserving surgery has to be considered in the early stages
- Intraoperative control of margins should be managed initially with fresh frozen sections
- Higher local recurrence rates are seen after penile-preserving surgery
- Reconstructive surgery has to be discussed for more advanced cases
Presented by: Chris Protzel, MD, PhD, Head of Urology, University Hospital Rostock, Head of the Urological Clinic, HELIOS Kliniken Schwerin, Rostock, Germany
Written by: Zachary Klaassen, MD, MSc, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Augusta, Georgia, Twitter: @zklaassen_md during the 1st Global Society of Rare Genitourinary Tumors Virtual Summit, December 11-12, 2020
1. Sri, Denosshan, Arunan Sujenthiran, Wayne Lam, Janice Minter, Brendan E. Tinwell, Catherine M. Corbishley, Tet Yap, Davendra M. Sharma, Benjamin E. Ayres, and Nick W. Watkin. "A study into the association between local recurrence rates and surgical resection margins in organ‐sparing surgery for penile squamous cell cancer." Bju International 122, no. 4 (2018): 576-582.