Abstract
ABSTRACTPurpose:To evaluate surgical complications and oncological outcomes of patients submitted to primary radical inguinal surgical debulking (PRISD) and myocutaneous pediculate flap reconstruction (MPFR) for locally advanced penile cancer (PC).Materials and Methods:Forty-two patients with ulcerated and/or fixed bulky inguinal masses underwent unilateral or bilateral PRISD with MPFR. Tensor fascia lata flap (TFL) was the standard of care for all patients. Additional use of the gracilis flap (GF) was carried out when necessary. Contra-lateral radical inguinal lymphadenectomy (RIL) was conduced when PRISD was performed unilaterally. Surgical complications were analyzed and stratified into minor and major according to the Bevan-Thomas classification. Adjunctive treatments were assessed and oncological outcomes analyzed.Results:Of the 42 patients evaluated, 10 (23.8%) underwent bilateral PRISD and 32 (76.2%) unilateral PRISD with contra-lateral RIL, totaling 84 lymphadenectomies. A total of 62 MPFRs were performed, 52 with TFL and 10 with GF. A total of 53 complications were identified, 49 related to PRISD with MPFR and 4 to RIL. Adjuvant chemotherapy was carried out in 16 patients. Median follow-up was 10.8 months with a median overall survival (OS) of 14.0 months against 6.0 months (p=0.006) for patients submitted to PRISD with adjuvant chemotherapy in relation to surgery alone.Conclusions:PRISD alone for advanced loco-regional PC is unlikely to promote long-term survival, although it can lead to temporary local control of the disease. Despite the feasibility of the procedure, it is related to high incidence of complications. Surgical treatment with adjuvant chemotherapy is associated with improved OS.
Highlights
Penile cancer (PC) is a rare neoplasm with low incidence in developed countries, in contrast with high incidence in developing countries, clearly indicating the disease’s association with local economic conditions [1, 2].Patients with PC tend to seek medical care belatedly, with about 15-50% of them presenting symptoms for more than one year
Patients All patients had squamous cell carcinoma of the penis and extranodal metastatic disease extension in the specimens obtained after primary radical inguinal surgical debulking (PRISD) procedure
All patients were staged through computerized tomography (CT) of the chest, abdomen and pelvis: 1 patient (2.4%) suffered from pulmonary metastasis and enlarged pelvic lymph nodes, 1 patient (2.4%) presented enlarged pelvic and retroperitoneal lymph nodes besides bulky cervical tumor, and 4 patients (9.5%) suffered from slightly enlarged pelvic lymph nodes
Summary
Patients with PC tend to seek medical care belatedly, with about 15-50% of them presenting symptoms for more than one year. 0-14% of patients with PC initially present locally advanced disease, with bulky metastatic lesions in the inguinal lymph nodes. Therapeutic options at this stage of the disease are usually scarce, limited to palliative radiotherapy and chemotherapy. Untreated, these patients have a mortality rate up to 90% in two years [8, 9]
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