Surgical treatment of advanced penile cancer: Beyond the Abstract

Penile cancer is rare in Western countries but not in developing countries. Such as in sub-Saharan Africa and parts of South America, where it accounts for around 10% of all male malignancies. The current therapies for advanced penile carcinoma include surgical therapy, radiotherapy, chemotherapy, or multimodality therapy, but the 5-year survival rate of these patients is only 7–50%. We report our experience of using surgical treatment in the management of patients with advanced penile cancer.

Twelve advanced penile cancer patients received partial penectomy or radical penectomy with inguinal lymph node dissection in Shanghai Ninth People’s Hospital, four of them received abdominal wall defect repair and skin grafting. No severe complications occurred during hospitalization, the flap for covering large area defects healed well and most of patients thought the surgery rewarding. The average followed up time is 16 months. Three patients are currently alive, and the other 9 patients died because of the progression of the original disease or distant metastases.

Treatment for advanced penile cancer is still a worldwide problem. The poor prognosis of advanced penile cancer is closely related to lymph node metastasis. The more lymph node metastases found, the worse the condition. Obviously, distant metastasis is also an important factor that affects prognosis. Patients with locally advanced disease without distant metastasis and N3 lymph node metastasis have a relatively long survival. Some scholars put forward multimodality therapy according to the poor effect of the treatment of advanced PC.

However, for the small number of cases treated with multimodalities, no consensus has been reached as to the appropriate approach for multimodality therapy for advanced PC. Although advanced PC is associated with poor prognosis, surgical treatment is still a relatively effective approach. Control of local and systemic disease, improving the quality of life is the goal of surgical treatment. Flap repair can solve the problem of skin defect after penectomy. The effect of the use of a myocutaneous flap was better because of abundant blood supply. It allowed for faster healing and reduce the risk of infection. Advanced penile cancer is difficult to treat regardless of chemotherapy or radiotherapy, and surgery cannot prolong the lives of patients.

However, dissection of lesions and repair of large area skin defects can dramatically improve quality of life, especially that of patients with locally advanced disease without distant metastasis.

Written By: Haijun Yao

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