Bilateral Dissection Research Articles

Delayed bilateral internal carotid artery dissection following motor vehicle accident: time to make its screening a part of trauma protocol?

Delayed bilateral internal carotid artery dissection following motor vehicle accident: time to make its screening a part of trauma protocol?

Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar - two cases report and literature review

BackgroundMalignant endometriosis in an episiotomy scar is rare; only seven cases have been reported previously. Here, we compare two cases of benign endometriosis and clear cell carcinoma.Case presentationThe first case was a 54-year-old woman who presented with a large perineal lesion in her episiotomy scar with high 18F-fluorodeoxyglucose uptake. This location had a history of endometriosis many years ago. She underwent radical excision of the mass and bilateral inguinal lymph node dissection. Histological and immunohistochemical analysis confirmed the presence of clear cell carcinoma arising from endometriosis. Assisted radiotherapy was performed after surgery due to a positive lymph node. No recurrence was detected over a 1-year follow-up period. The second case deals with a 3 × 2 cm mass in the episiotomy scar of a 33-year-old woman. Part of the anal sphincter was resected because of the close proximity of the lesion. Because the disease lay very close to the anus, she received anal sphincter reconstruction combined with mass excision. Pathology result showed typical endometrial glands and interstitial tissues.ConclusionsDeleterious change only happens in patients experiencing perineal endometriosis. Complete excision is crucial for this form of disease; sometimes impairment of the anal sphincter is also necessary. Patients with malignancy required a combination of treatments in order to improve their prognosis.

Controversies in the Management of Lateral Pelvic Lymph Nodes in Patients With Advanced Rectal Cancer: East or West?

The presence of lateral pelvic lymph nodes (LPLN) in advanced rectal cancer entails challenges with ongoing debate regarding the role of prophylactic dissection vs. neoadjuvant radiation treatment. This article highlights the most recent data of both approaches: bilateral LPLN dissection in every patient with low rectal cancer (Rb) as per the Japanese guidelines, vs. the developing approach of neoadjuvant radiotherapy as per Eastern countries. In addition, we also accentuate the importance of a combined approach published by Sammour et al. where a simple “one-size-fits-all” strategy should be abandoned. Rectal cancer treatment is well-established in Western countries. Patients with advanced rectal cancer will undergo radiation ± chemo neoadjuvant therapy followed by TME. In the Dutch TME trial, TME plus radiotherapy showed that the presacral area was the most frequent site of recurrence and not the lateral pelvic wall. Supporting this data, the Swedish study also concluded that LPLN metastasis is not an important cause of local recurrence in patients with low rectal cancer. Therefore, Western approach is CRM-orientated and prophylactic LPLN dissection is not performed routinely as the NCCN guideline does not recommend its surgical removal unless metastases are clinically suspicious. The paradigm in Eastern countries differs somewhat. The Korean study demonstrated that adjuvant radiotherapy without lateral lymph node dissection was not enough to control local recurrence and LPLN metastases. The Japanese Trial JCOG 0212 demonstrated the effects of LPLN dissection in reducing local recurrence in the lateral pelvic compartment. We agree with Sammour and Chang on the fact that rather than a mutual exclusivity approach, we should claim for an approach where all available modalities are considered and used to optimize treatment outcomes, classifying patients into 3 categories of LPLN: low risk cT1/T2/earlyT3 (and Ra) with clinically negative LPLN on MRI; Moderate risk (cT3+/T4 with negative LPLN on MRI) and high risk (clinically abnormal LPLN on MRI). Treatment modality should be based on detailed pretreatment workup and an individualized approach that considers all options to optimize the treatment of patients with rectal cancer in the West or the East.

Vulvar cancer: surgical management and survival trends in a low resource setting

BackgroundThis study aims to analyze risk factors, clinical profiles, treatment protocols, and disease outcomes in histologically proven resectable vulvar cancer (VC) patients according to tumor stage. This is a retrospective analysis of a prospectively collected database of 20 VC patients from May 2014 to June 2019.ResultsThe mean age of VC diagnosis was 55 years, with a range of 38–84 years. The incidence was four cases per year. The disease incidence was significantly more in post-menopausal (65%) and multiparous (90%) women. According to FIGO staging of vulvar cancer, stages I, II, and III were assigned to 6, 1, and 11 patients respectively. Two patients suffered from stage IVa vulvar melanoma. All patients had undergone surgical interventions. Patients treated with only nonsurgical (chemotherapy/radiotherapy/chemo-radiotherapy) treatment modalities were excluded from the study. Fifteen patients were treated with wide local excision (WLE), bilateral inguinofemoral dissection (B/L IFLND), and primary repair. Four and one patients were treated with radical vulvectomy (RV) and modified radical vulvectomy (MRV) [with or without B/L IFLND and PLND] respectively. Reconstruction with V-Y gracilis myocutaneous and local rotation advancement V-Y fasciocutaneous flaps were done in two patients. Therapeutic groin nodal dissection was performed in 19 patients except in one patient who was treated by palliative radical vulvectomy. In the final histopathology reports, tumor size varies from 0.5 to 6.5 cm (mean 3.35 cm) with the predominance of squamous cell carcinoma (18 out of 20 patients). Only 10 out of 18 eligible patients received adjuvant treatment. Poor patient compliance has been one of the major reasons for adjuvant treatment attrition rate. Systemic and loco-regional metastasis occurred in 3 patients each arm respectively. Poor follow up of patients is the key limitation of our study.ConclusionVulvar cancer incidence was significantly high in post-menopausal and multiparous women. The most important prognostic factors were tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.

Vascularization of the superficial circumflex iliac perforator flap (SCIP flap): an anatomical study.

The superficial circumflex iliac artery perforator flap (SCIP) has gained widespread popularity as local or free flap to cover soft tissue defects. However, there are numerous anatomical variations in terms of size, location and reliability of its perforators This cadaveric study aimed to focus on the anatomical bases of this flap. A bilateral dissection of seven cadavers was performed to harvest 14 flaps. Superficial circumflex iliac artery parameters, number, length and diameters of perforators were measured. Correspondent perforasomes were highlighted through semi-selective injections. The major perforator of the superficial branch had a mean caliber of 2.0mm, and a mean length of 1.8mm. The major perforator of the deep branch had a mean caliber of 2.1mm and a mean length of 1.43mm. The mean area of the superficial pattern perforasome was 178.6 cm2 and the mean measured surface of the deep pattern perforasome was 156.2 cm2. The descending branches of the deep branch anastomosing with the ascending branch of the lateral circumflex femoral artery were found in three cases. Several anatomical variations were observed in this anatomical study, but major perforators supplying large perforasomes were always found.

Negative Pressure Wound Therapy (NPWT) in Groin Wounds After Lymphadenectomy in Vulvar Cancer Patients.

Vulva cancer surgery is associated with a high level of morbidity mostly due to wound healing disorders in the inguinal region following lymphadenectomy. Our aim is to evaluate the feasibility of negative pressure wound therapy (NPWT) using the PICO™ device in groin wounds after lymphadenectomy. The groins of twenty patients who underwent bilateral lymph node dissection were dressed with the PICO™ device. All patients were followed prospectively with clinical controls up to three months postoperatively using a standardized study protocol. A total of 11 patients (55%) developed a surgical site complication (SSC). One patient suffered from a wound rupture two days after surgery, six a lymphocele and four a surgical site infection. Operation time, blood loss, number of lymph nodes removed, length of hospital-stay and duration of PICO™ treatment did not differ between women with and without SSCs. NPWT using the PICO™ device seems to be a feasible method to reduce the severity of healing disorders in the groin after lymphadenectomy in vulva cancer patients.

Bilateral Carotid Dissection Caused by a Dog Bite: Case Report and Review of the Literature

Bilateral Carotid Dissection Caused by a Dog Bite: Case Report and Review of the Literature

Bilateral vertebral artery dissections involving the left vertebral artery of aortic origin: A case report

Bilateral vertebral artery dissections involving the left vertebral artery of aortic origin: A case report

Elective Central Compartment Lymph Node Dissection Does not Increase the Risk of Postoperative Hypoparathyroidism in Patients Treated for Differentiated Thyroid Cancer

SUMMARYAimThe aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer.MethodsA retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups.ResultsA total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant.DiscussionWhile its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies.ConclusionOur results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.

Robot-assisted laparoscopic retroperitoneal lymph node dissection: a minimally invasive surgical approach for testicular cancer

Retroperitoneal lymph node dissection (RPLND) can been employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. Open RPLND (O-RPLND) has long been the standard approach for lymphadenectomy, but is associated with significant morbidity. Laparoscopic RPLND (L-RPLND) was developed to mitigate the morbidity associated with O-RPLND, but is a technically challenging procedure requiring significant experience with laparoscopic dissection and suturing to remove lymph nodes behind the great vessels and to control vascular injury. Robotic RPLND (R-RPLND) has gained traction in recent years as an alternative to both O-RPLND and L-RPLND. With superior instrument dexterity and better visualization compared to L-RPLND, and with decreased morbidity, compared to O-RPLND, R-RPLND can be performed safely and effectively. With the latest advances in robotic technology, one can perform a full bilateral dissection without needing to reposition the patient or redock the robot. R-RPLND has been applied for both primary treatment as well as in patients with post-chemotherapy residual abdominal masses.

Deep cervical fascia as an anatomical landmark of lingual lymph nodes: An anatomic and histologic study

ObjectivesWe aimed to discuss the definition of lingual lymph nodes based on the deep cervical fascia anatomy. MethodsA total of 11 cadavers were histopathologically evaluated. Specimens were dissected into serial stepwise cross-sections. The deep cervical fascia and lymph nodes were evaluated by staining the cross-sections with Elastica van Gieson and hematoxylin and eosin stains, respectively. The gross anatomy of the deep cervical fascia was evaluated in 1 cadaver after bilateral dissection. ResultsA single severely degenerated medial lingual lymph node (MLLN) was identified in the lingual septum of 1 cadaver. A single lateral lingual lymph node (LLLN) was identified in 1 cadaver, between the genioglossus and the hyoglossus. The superficial layer of deep cervical fascia (SLDF) was found to split into two layers encapsulating the submandibular gland. The deeper portion of this fascia was in close contiguity with the hyoglossus and formed the boundary between the mouth and the neck. The SLDF was found to be discontinuous with the area between the sublingual space and the submandibular gland. ConclusionsThe SLDF could serve as an anatomical landmark for lingual lymph nodes, since it is considered to be the demarcating boundary during neck dissection. When lymph nodes that are located deeper than the SLDF were defined as lingual lymph nodes, 1 MLLN and 1 LLLN were identified.

Successful Endovascular Treatment of Bilateral Carotid Dissection in a Near-Hanging Victim

Introduction - Blunt cervical carotid artery injury has been reported in 0.1% to 1.55% of all trauma patients1. Improved understanding of the injury mechanism and the availability of noninvasive imaging techniques have led to more comprehensive screening of trauma patients and an increase in diagnosis.

Empty hemiscrotum and a giant abdominal mass case report

Testicular germ cell tumors are the most common adult male malignancy among men 20–35 years, having a favorable prognosis when detected at early stages. Testicular teratomas are derived from embryonic tissue within gonads and tend to exhibit locally invasive and chemo resistant behavior. Cryptorchidism is a significant risk factor for the development of testicular germ cell tumors, therefore, patients with undescended testicles should be closely monitored. Pre-pubertal orchiopexy should be considered to reduce the risk of germ cell tumors and improve its early detection. We report a 26-year-old male with an empty hemiscrotum who incidentally presented with a large intraabdominal mass after being evaluated for a broken jaw. He was lost to follow-up and re-presented with a 19 cm intraabdominal mass and alpha-fetoprotein of 5,310 ng/mL, beta-human chorionic gonadotrophin of 0.5 MIU/mL, and a lactate dehydrogenase of 846 U/L. After completion of four cycles of paclitaxel, ifosfamide, and cisplatin chemotherapy, he underwent a left orchiectomy, bilateral full template retroperitoneal lymph node dissection, and a partial cystectomy. Final pathology revealed a malignant mixed germ cell tumor consisting of 75% immature teratoma, 25% mature teratoma, and involvement in zero of twenty-three retroperitoneal lymph nodes. The patient recovered well with no signs of recurrence. This case highlights the importance of proper genitourinary assessment during routine physical examinations and close follow-up of adult patients with cryptorchidism.

The value of PET/CT in determining lymph node metastasis of endometrial cancer.

In our study, the role of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) in determining lymph node metastasis of endometrial cancer was evaluated. The present retrospectively registered study included 80 patients with endometrial cancer who underwent PET/CT in preoperative period. The patients underwent total hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection. Lymph node status was evaluated in histopathologic examination and PET/CT imaging and, the results were compared. There were 80 patients (mean age 62 years) in the present study. Lymph node metastasis was detected in five patients, whereas 75 patients had no lymph node metastasis. A total of 1,471 lymph nodes were examined histopathologically, revealing benign findings in 1,433 (pelvic = 1018, paraaortic = 415) and malignant findings in 38 (pelvic = 28, paraaortic = 10) lymph nodes. The accuracy, sensitivity and specificity of PET/CT in determining lymph node metastasis was 95%, 80% and 96% in patient-based evaluation, and 97.4%, 78.9% and 98.6% in lymph node-based evaluation, respectively. The detection sensitivity of PET/CT was 0%, 81.4% and 100% in metastatic lymph nodes with a short diameter of ≤ 4 mm, 5-9 mm and ≥ 10 mm, respectively. PET/CT could detect 73.3% of metastatic lymph nodes that had < 10 mm short diameter. PET/CT is useful method in detecting lymph node metastasis especially that are disregarded by CT or MR in endometrial cancer. Although PET/CT doesn't fully replace the surgical staging, its utilization in preoperative period may guide surgical procedure.

Vertebral Artery Dissection Following Cervical Spine Injury as a Diagnostic Challenge. Case Study

Head and neck injuries are common and can be associated with cervical vessel injury. In some cases, the cor-rect diagnosis of artery dissection can be a real challenge given the nonspecific signs. We present the case of a spinal cord-injured patient with neurological sequelae and delayed posterior circu-la-tion stroke caused by bilateral vertebral artery dissection. The signs of cerebellar and occipital lobe ischemia were masked by manifestations of spinal cord injury. The patient was unconscious and in a serious condition, but, despite no proper stroke treatment, only residual dysarthria and upper limb ataxia were seen after reha-bilitation. Any clinical suspicion based on the combination of head or neck trauma with atypical or evolving neuro-logical symptoms should be verified for the possibility of a vertebral artery dissection.

Prognostic significance of common preoperative laboratory variables in penile squamous cell carcinoma.

To investigate the predictive value of common preoperative laboratory variables in patients undergoing bilateral inguinal lymph node dissection surgery for penile squamous cell carcinoma. We retrospectively analyzed the records of 228 patients who had bilateral inguinal lymph node dissection for penile squamous cell carcinoma to assess the following clinical factors: preoperative laboratory measurements, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum calcium, total protein, globulin, pathological factors and survival rates after surgery. The percentage of positive lymph nodes was 52.6%. Univariate analysis showed that the tumor stage and grade, the presence of metastasis, white blood cellcount, platelet count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and globulin were significantly associated with the disease-specific survival (all P<0.05). At multivariate analysis, only the neutrophil-to-lymphocyte ratio had an independent effect (hazard ratio 2.131; P=0.035). The predictive accuracy of the neutrophil-to-lymphocyte ratio was the best among the laboratory variables. The predictive accuracy of the basic pathological factors was significantly increased by incorporating the neutrophil-to-lymphocyte ratio prognosticator. The neutrophil-to-lymphocyte ratio before inguinal lymph node dissection might be useful for predicting the prognosis of patients with penile squamous cell carcinoma.

Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis\u2014a case-control study

BackgroundEndometriosis can exert obvious negative effects on women’s quality of life.Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods with a view to improving the quality of the treatments provided.MethodsThe present prospective double-blind randomized clinical trial was conducted on 50 women of reproductive age (≥ 19 years) diagnosed with severe pelvic endometriosis on transvaginal ultrasound scans and vaginal examinations at Yas Hospital between 2014 and 2017. Women with severe endometriosis (stage III, stage IV, and deep infiltrating endometriosis) requiring an extensive bilateral dissection of the pelvic walls and the rectovaginal space, with preserved uterus and ovaries, were included in the study.The preoperative severity of ovarian adhesions was assessed in terms of ovarian motility, measured through a combination of gentle pressures applied with the vaginal probe and abdominal pressures applied with the examiner’s free hand. A table of random numbers was used to choose which ovary to suspend. The entire study population received standard general anesthesia. In the laparoscopic examination of the cases with severe endometriosis, both ovaries were routinely suspended to the anterior abdominal wall with PROLENE sutures. At the end of the surgery, one of the ovaries was kept suspended for 7 days, whereas the other ovarian suspension suture was cut.At 3 months postoperatively, all the patients underwent ultrasound scans for the assessment of ovarian motility and adhesions. The severity of pelvic pain was defined according to a visual analog score. After surgery, infertile women were followed for 2-4 years, and were contacted regarding the infertility treatment. Chemical and clinical pregnancy rates was compered between the two groups.ResultsThree months after laparoscopy, the adhesions were mild in 41 (82%) patients and moderate in 9 (18%) on the suspended side, and mild in 12 (24%) patients and moderate in 38 (76%) on the control side (P < 0.001). The mean dysmenorrhea score was 6.8 ± 1.5 before surgery and 4.5 ± 1.4 after surgery (P < 0.001). The chemical pregnancy rate and clinical pregnancy rate were not different in the suspended and control groups (P = 0. 62, P = 0.64).ConclusionsThe reduction in adhesions via ovarian suspension surgery promises reductions in the complications of endometriosis.

Histopathological risk scoring system as a tool for predicting lymph nodal metastasis in penile squamous cell carcinoma

Penile cancer is an aggressive neoplasm and nodal metastasis is a key factor in determining the outcome. While there is a paucity of tools predicting nodal metastasis, an elective groin node dissection (GND) may cause severe morbidity. We aimed to devise a histopathology-based risk stratification system to predict the risk of nodal metastasis in penile squamous cell carcinoma (SCC) patients. In this retrospective clinicopathological analysis, consecutive penile SCC patients who had undergone primary surgical treatment with GND from 2007 to 2012 were included. Histopathology slides were reviewed and a histopathological risk scoring system (ranging from 3 to 9) was devised by adding the values assigned to the following pathological variables: tumour grade (1-3); anatomical level of infiltration (1-3); and tumour infiltration pattern (1-3). Three risk groups were created based on histopathological risk scores. Final scores and risk groups were correlated with nodal metastasis, disease-free survival (DFS) and overall survival (OS). We also validated the earlier described prognostic index score (PIS) on our set of patients and compared it to our proposed scoring system. A total of 162 cases of primary penile resections with unilateral or bilateral groin node dissection were identified during the study period. Sixty-two of 68 patients (91.17%) and 58 of 94 patients (61.7%) had nodal metastasis on upfront and follow-up nodal basin surgeries, respectively. Chances of nodal metastasis for each risk group were as follows: low risk (score 3 and 4) 14.3%; intermediate risk (score 5) 52.6%; and high risk (scores 6-9) 83.7%. Follow-up was available in 145 patients (89.5%). Median follow-up was 21 months (1-96 months). The histopathological scoring system (p=0.04) and risk groups (p=0.005) had a statistically significant correlation with DFS but not with OS. Logistic regression model demonstrated that this stratification system was a good predictor of nodal metastasis. Further, this scoring system had better predictive sensitivity for detecting true node-negative cases and marginally better accuracy in detecting nodal metastasis as compared to the PIS. Our study demonstrates that the histopathological risk stratification can predict nodal metastasis and aid in planning management of penile cancer patients with judicious implementation of the morbid procedure of GND.

Genitofemoral Nerve Sparing Adhesiolysis

Video Objective The objective of this video is to review the anatomical landmarks, innervations and mechanisms of injury of the genitofemoral nerve in order to avoid its injury in cases with significant pelvic adhesions. Setting The patient is a thirty-two-year-old gravida three para three who is known for endometriosis. She previously underwent a caesarean hysterectomy for invasive placentation. She presented with chronic pelvic pain. She tried numerous medical treatments; only GnRH agonist controlled her pain. She was therefore consented for laparoscopic bilateral salpingo-oophorectomy which was performed at a tertiary care center by the minimally invasive gynecology surgery team. She had extensive abdominal and left pelvic side wall adhesions. In fact her left ovary was severely adherent onto the left external iliac artery and genitofemoral nerve. Interventions During the laparoscopic bilateral salpingo-oophorectomy, adhesiolysis and dissection near the genitofemoral nerve and external iliac artery were performed. Conclusion In the case of severe pelvic side wall adhesions and absence of a uterus, recognition of pelvic landmarks is of paramount importance. This facilitates identification of other pelvic structures and in this case, prevented injury to the external iliac artery and the genitofemoral nerve. Furthermore, careful tissue handling and dissection techniques are crucial. These help to maintain minimal blood loss, develop surgical planes and avoid injuries to pelvic structures.

A Retrospective Analysis of Carcinoma Penis Patients Treated at a Cancer Center in Nepal in a Period of Five Years

Introduction: Carcinoma Penis is not an uncommon condition in a developing country like Nepal and comprises 1-10% of all the malignancies in males. In this study we analyzed the demographic and clinicopathological profile of penile cancer patients who visited our cancer center during specified period.&#x0D; Methods: This is a descriptive cross-sectional study, that altogether included 218 patients from January 2012 to December 2016 with penile cancer conducted at B P Koirala Memorial Cancer Hospital, Nepal. All the demographic and clinico-pathological data were collected and analyzed using SPSS 16.0 software. Tumor staging was standardized according to the American Joint Committee on Cancer system. Quantitative data were represented as mean and standard deviation whereas categorical variables were expressed as frequencies and percentages of an appropriate denominator.&#x0D; Results: Among 218 patients, the mean ± SD age was 53.94 ± 13.69 years. Most were married (88.07%), smokers (67.88%), had poor personal hygiene (70.64%) and had not completed primary school (71.64%). The predominant profession was agriculture (81.65%). Most of the patients (56.88%) were diagnosed in clinical stage III b (T1-3, N2). Management was circumcision alone in 5.5%, Wide local excision in 6.88%, partial penectomy in 66.97% patients, total penectomy with perineal urethrostomy in 11% of patients and 9.63% patients were sent for chemotherapy after initial biopsy for fixed and fungating inguinal nodes. Bilateral inguinal lymph node dissection was performed in 87.15% patients. Most of our patients were uncircumcised (90.82%) Squamous cell carcinoma was the commonest histopathology (98.6%).&#x0D; Conclusion: Penile cancer is more common among farmer with low socioeconomic status. The disease is already locally advanced and at the time of diagnosis. Surgery is the main modality of treatment.