{"title":"Phallus preservation and reconstruction: 5-year outcomes of national penile cancer centralisation in the Republic of Ireland","authors":"","doi":"10.1016/j.surge.2024.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span><span>Penile cancer is a rare urological </span>malignancy with an age-standardised incidence of 0.8 per 100,000 person-years [1]. Given this low incidence it has been suggested that centralised care may improve patient outcomes in relation to </span>phallus sparing surgery and nodal assessment [2]. We aim to assess the outcomes after 5-years of national centralisation of penile cancer care.</p></div><div><h3>Methods</h3><p>A retrospective analysis of prospectively collected data was performed. All patients undergoing penile cancer surgery from January 2018 to December 2022 following centralisation of care were included. The primary outcome was proportion of phallus sparing procedures performed. Secondary outcomes were patient characteristics, histologic outcomes and procedures performed.</p></div><div><h3>Results</h3><p><span>124 patients underwent surgery in the study period. Mean age was 64.49 (±13.87). Overall, 82.3% of patients underwent phallus sparing surgery. This remained stable over the 5-year period from 2018 to 2022 at 92%, 85%, 76%, 79% and 78% respectively (p = 0.534). 62.7% had reconstruction performed, including split-thickness skin graft neoglans formation, (57.8% [n = 37]), preputial flap (32.8% [n = 21]), glans resurfacing (4.7% [n = 3]), shaft advancement flap (1.6% [n = 1]), penile shaft skin graft (1.6% [n = 1]), and partial </span>penectomy with urethral centralisation (1.6% [n = 1]). Phallus preservation was not affected by positive nodal status (OR 0.75 [95% CI 0.249–2.266], p = 0.564) or T-stage ≥1b (OR 0.51 [95% CI 0.153–1.711], p = 0.276). There has been a significant reduction in Nx nodal status from 64% in 2017 to 15% in 2021 (p = 0.009).</p></div><div><h3>Conclusion</h3><p>Centralisation of treatment for rare malignancies such as penile cancer may improve oncologic outcomes and rates of phallus preservation. This study has shown centralisation to has a high rate of phallus preservation. Further long-term analysis of outcomes in Ireland is required.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Pages 292-295"},"PeriodicalIF":2.3000,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1479666X24000337","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Penile cancer is a rare urological malignancy with an age-standardised incidence of 0.8 per 100,000 person-years [1]. Given this low incidence it has been suggested that centralised care may improve patient outcomes in relation to phallus sparing surgery and nodal assessment [2]. We aim to assess the outcomes after 5-years of national centralisation of penile cancer care.
Methods
A retrospective analysis of prospectively collected data was performed. All patients undergoing penile cancer surgery from January 2018 to December 2022 following centralisation of care were included. The primary outcome was proportion of phallus sparing procedures performed. Secondary outcomes were patient characteristics, histologic outcomes and procedures performed.
Results
124 patients underwent surgery in the study period. Mean age was 64.49 (±13.87). Overall, 82.3% of patients underwent phallus sparing surgery. This remained stable over the 5-year period from 2018 to 2022 at 92%, 85%, 76%, 79% and 78% respectively (p = 0.534). 62.7% had reconstruction performed, including split-thickness skin graft neoglans formation, (57.8% [n = 37]), preputial flap (32.8% [n = 21]), glans resurfacing (4.7% [n = 3]), shaft advancement flap (1.6% [n = 1]), penile shaft skin graft (1.6% [n = 1]), and partial penectomy with urethral centralisation (1.6% [n = 1]). Phallus preservation was not affected by positive nodal status (OR 0.75 [95% CI 0.249–2.266], p = 0.564) or T-stage ≥1b (OR 0.51 [95% CI 0.153–1.711], p = 0.276). There has been a significant reduction in Nx nodal status from 64% in 2017 to 15% in 2021 (p = 0.009).
Conclusion
Centralisation of treatment for rare malignancies such as penile cancer may improve oncologic outcomes and rates of phallus preservation. This study has shown centralisation to has a high rate of phallus preservation. Further long-term analysis of outcomes in Ireland is required.
期刊介绍：
Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field.
Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion.
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