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The Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Invasive Penile Cancer Confined to Glans - Beyond the Abstract

In Western Countries (EU and USA) penile cancer (PC) can be considered a quite rare condition since its estimated incidence is about 1/100000 per year.1-3 Despite the rarity of PC, the diagnostic and therapeutic process represents a very important step for the patients and at the same time it is challenging and stimulating for reconstructive urologists. PC surgical management has obvious consequences on patients’ urinary and sexual function and on the overall quality of life.

The main aim of the reconstructive urologist consists precisely in limiting these drawbacks, optimizing post-surgical functions and appearance.6-9 The historical approach for penile lesions generally consisted of a total or subtotal penile amputation with a large surgical margin of healthy tissue. This approach has proven to be extremely demolishing and disabling from all points of view (functional and aesthetical) but it was certainly safe in terms of oncological control.10-13

Currently, this invasive approach is no longer to be considered the gold standard. Over time, less invasive and disabling surgical techniques have been developed while maintaining an excellent rate of oncological radicalization. Furthermore, available data showed that the organ-sparing approaches, although burdened by a higher rate of local recurrence, did not deteriorate patients overall survival.14-17

It is true that, in case of local recurrence, patients need to undergo revision surgery. But when the local recurrence does not occur (most of cases), patients will benefit from the preserved urinary and sexual function as well as the aesthetic appearance, compared to a simple amputation approach.18-26

Organ-sparing management include different techniques that are proposed and performed as a valuable option to manage superficial, localized, or locally advanced PC to provide curative resection while preserving sexual and urinary functions and minimizing psychological harm. Total glans resurfacing (TGR) and glansectomy (GS) are the two most common and described approaches. In both cases the penile lesion is removed, frozen sections are performed to guarantee disease-free surgical margin and finally, an effective functional aesthetic reconstruction with split-thickness skin graft (STSG), harvested from the thigh, is carried out.18-26

In penile reconstruction, a wide consensus among reconstructive genital surgeon can be found on the use of STSG, as it guarantees higher rates of graft take and it allows the detection of a local recurrence. Focusing on glans reconstruction, considering the small size of the area involved and the need for an aesthetic scarring, we do not recommend the use of a meshed STSG.

Given the consequences of PC and the importance of its optimal management in terms of both oncological radicality and aesthetic and functional penile reconstruction, it is mandatory that these cases are only treated in referral centers. Moreover, genitourinary reconstructive surgeons should perform, where possible, the most suitable organ sparing technique to optimize oncological, functional, and post-operative satisfaction outcomes. Decentralized management of PCs, due to its rarity, does not allow to obtain and maintain adequate surgical expertise of the disease.

Written by: Mirko Preto,1 Marco Falcone,1,2 Massimiliano Timpano,1 Federica Peretti,1 Lorenzo Cirigliano,1 Ilaria Ferro,1 Natalia Plamadeala,1 Carlotta Mangione,1 Paolo Gontero1

  1. Urology Clinic - A.O.U. “Città della Salute e della Scienza” – Molinette Hospital, University of Turin, Italy
  2. Neurourology Clinic - A.O.U. “Città della Salute e della Scienza” - Unità Spinale Unipolare, Italy

References:

  1. Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control 2009;20:449–57.
  2. Chaux A, Netto GJ, Rodriguez IM, et al. Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma. World J Urol 2013; 31:861–7.
  3. Albersen M, Parnham A, Joniau S, Sahdev V, Christodoulidou M, Castiglione F, Nigam R, Malone P, Freeman A, Jameson C, Minhas S, Ralph DJ, Muneer A. Predictive factors for local recurrence after glansectomy and neoglans reconstruction for penile squamous cell carcinoma. Urol Oncol. 2018 Apr;36(4):141-146.
  4. Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015 Jan;67(1):142-150. doi: 10.1016/j.eururo.2014.10.017. Epub 2014 Nov 1. PMID: 25457021.
  5. Flaig TW, Spiess PE, Agarwal N et al. National Comprehensive Cancer Network - NCCN - Guidelines Penile Cancer - Version 1.2022.
  6. Sedigh O, Falcone M, Ceruti C, Timpano M, Preto M, Oderda M, Kuehhas F, Sibona M, Gillo A, Gontero P, Rolle L, Frea B. Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results? Can Urol Assoc J. 2015 Jul-Aug;9(7-8):E423-7.
  7. Parnham AS, Albersen M, Sahdev V, Christodoulidou M, Nigam R, Malone P, Freeman A, Muneer A. Glansectomy and Split-thickness Skin Graft for Penile Cancer. Eur Urol. 2018 Feb;73(2):284-289.
  8. Kieffer JM, Djajadiningrat RS, van Muilekom EA, et al. Quality of life in patients treated for penile cancer. J Urol 2014;192:1105-10.
  9. Palminteri E, Fusco F, Berdondini E, et al. Aesthetic neo-glans reconstruction after panis sparing surgery for benign, premalignant or malignant penile lesions. Arab J Urol 2011.
  10. Das S. Penile amputations for the management of primary carcinoma of the penis. Urol Clin North Am. 1992 May;19(2):277-82.
  11. D’Ancona CA, Botega NJ, De Moraes C et al. Quality of life after partial penectomy for penile carcinoma. Urology 1997;50:593-6.
  12. Romero FR, Romero KR, Mattos MA, et al. Sexual function after partial penectomy for penile cancer. Urology 2005;66:1292-5.
  13. Opjordsmoen S, Fosså SD. Quality of life in patients treated for penile cancer. A follow-up study. Br J Urol 1994;74:652-7.
  14. Hoffman MA, Renshaw AA, Loughlin KR. Squamous cell carcinoma of the penis and microscopic pathologic margins: How much margin is needed for local cure? Cancer 1999;85:1565-8.
  15. Minhas S, Kayes O, Hegarty P, et al. What surgical resection margins are required to achieve oncological control in men with primary penile cancer? BJU Int 2005;96:1040-3.
  16. Maddineni SB, Lau MM, Sangar VK. Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer. BMC Urol 2009;9:8.
  17. Smith Y, Hadway P, Biedrzycki O, et al. Reconstructive surgery for invasive squamous carcinoma of the glans penis. Eur Urol 2007;52:1179–85.
  18. Philippou P, Shabbir M, Malone P, et al. Conservative surgery for squamous cell carcinoma of the penis: resection margins and longterm oncological control. J Urol. 2012;188:803–808.
  19. BurnettAL. Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol 2016;13:249–57.
  20. Beech BB, Chapman DW, Rourke KF. Clinical outcomes of glansectomy with split-thickness skin graft reconstruction for localized penile cancer. Can Urol Assoc J. 2020 Oct;14(10):E482-E486.
  21. Garaffa G, Shabbir M, Christopher N, et al. The surgical management of lichen sclerosus of the glans penis: our experience and review of the literature. J SexMed 2011 Apr;8(4):1246–1253.
  22. Scarberry K, Angermeier KW, Montague D, et al. Outcomes for organ-preserving surgery for penile cancer. Sex Med 2015;3:62-6.
  23. Morelli G, Pagni R, Mariani C, et al. Glansectomy with split-thickness skin graft for the treatment of penile carcinoma. Int J Impot Res 2009;21:311–4.
  24. O’Kelly F, Lonergan P, Lundon D, et al. A prospective study of total glans resurfacing for localized penile cancer to maximixe oncologic and functional outcomes in a tertiary referral network.
  25. Hadway P, Corbishley CM,Watkin NA. Total glans resurfacing for premalignantlesions of the penis: Initial outcome data. BJU Int.2006;98:532–536.
  26. Preto M, Falcone M, Blecher G, et al. Functional and Patinet Reported Outcomes Following Total Glans Resurfacing. Sexual J 2021.

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