The surgical management of penile cancer at the Free State academic complex: a review

[摘要] Introduction and aimCurrently there exist limited data about the management of penile cancer in South Africaand there are no centres of excellence for managing this malignancy. Therefore thesepatients are managed by different treatment strategies at different health facilitiesthroughout the country.The aim of this study isi. To describe the profile of men with penile cancer at our centre and compare it to theprofile of men as described in the published literatureii. To evaluate the incidence of histologically node-positive patients and the earlycomplication rate of patients undergoing simultaneous inguinal lymph node dissection(ILND) during surgery for penile carcinoma andiii. To describe the incidence of the different histological subtypes found at the Free StateAcademic ComplexMethodsForty-one patients that presented with histologically confirmed penile cancer who weretreated with surgery at the Free State Academic Complex between 2005 and 2015 wereincluded. The data variables (that were analysed) included: Patients demographics, preoperativepenile biopsy results, type of surgery performed, results of final histology ofprimary penile cancer and dissected lymph nodes, and early lymph node dissectioncomplications. Primary penile surgery and lymph node management were managedaccording to our evolving centre protocol.ResultsA total of 41 patients with histologically confirmed penile cancer were surgically treated. Themean age was 50 years (range 30-86 years). Human Immunodeficiency Virus (HIV) statuswas known in 20 patients and revealed positive results in 16 (80%) patients.From a cohort of 41 patients, 25 patients underwent lymph node dissection for clinicallypalpable nodes or grade pT1 or higher disease. Of these 25 patients, eight patients (32%)had lymph node metastasis, and 17 patients (68%) showed no evidence of nodalmetastasis. Of the eight patients with positive nodes, five patients had unilateral groinpositive nodes and three patients had bilateral groin involvement.Out of 41 patients, 25 patients underwent primary penile surgery (glansectomy, partial (or)total penectomy with perineal urethrostomy) and inguinal lymph node dissectionsimultaneously. Complications associated with simultaneous penile surgery and lymphnode dissection were seromas in two patients (8%), one superficial wound infection (4%)and 17 patients (68%) did not have post-operative complications. Five patients (20%) werelost to follow-up postoperatively.All 41 patients (100%) had squamous cell carcinoma (SCC), and the predominanthistological subtype was classic SCC in 36 patients (87%). This was followed by wartycancer subtype in three patients (7.3%), verrucous subtype in three patients (7.3%) andone patient (2.4%) had poorly differentiated cancer with spindle cell component.ConclusionEarly age of presentation and high prevalence of HIV was observed in the present studywhich is in line with other published literature studies. Simultaneous primary penile surgeryand inguinal lymphadenectomy can be done safely in a population with a high incidence ofinfection and HIV-associated lymphadenopathy. In our setting, where non-compliance andlost to follow-up rates are high, simultaneous primary penile and node dissection isadvisable, but the importance of serial follow-up for recurrences and distal metastasescannot be ignored. The high incidence of node negative ILND in the current study was alsoobserved. Penile cancer histological subtypes correlates with published literature despitehigh prevalence of HIV infection.

[发布机构] University of the Free State