Comparative Outcomes of Partial Versus Total Penectomy for Penile Carcinoma: A Retrospective Cohort Study on Demographics and Postoperative Complications

Partial penectomy (PP) is often preferred over total penectomy (TP) in penile cancer treatment due to the former’s better preservation of functional urinary outcomes. However, there has not been a direct comparison of perioperative outcomes between PP and TP until now. This study aimed to report differences in preoperative risk factors, intraoperative outcomes, and postoperative outcomes between TP and PP for penile cancer using data from the National Surgical Quality Improvement Program (NSQIP) database between 2006 and 20161.

In summary, a total of 260 patients were included in the study, with 67 undergoing TP and 193 undergoing PP. The results indicated that PP patients were less likely to be transferred patients (p=0.002), less likely to be diabetic (p=0.026), and more likely to have preoperative laboratory values within normal limits. PP patients also had shorter lengths of hospital stay (p<0.001) and operating times (p<0.001). Significant differences were also found in inpatient stay (p<0.001), 30-day post-surgery complications (p<0.001), deep incisional surgical site infections (SSI) (p=0.017), wound disruption (p=0.017), intraoperative or postoperative transfusion (p=0.029), and sepsis (p<0.005). Additionally, PP patients required fewer concurrent surgical procedures (p<0.001).

The demographic differences between PP and TP patients may reflect more advanced oncologic disease presentations in TP patients.² Our study highlights that PP is associated with fewer postoperative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures compared to TP.¹ However, there remains a gap in the reported data pertaining to postoperative sexual function and erectile outcomes for PP at a national level.³

The rarity of penile cancer in the United States and other developed countries has made comparative studies challenging. The American Society of Clinical Oncology (ASCO) and European Association of Urology (EAU) guidelines on penile cancer are primarily based on expert opinion and case series, rather than large prospective randomized controlled trials.⁴ In line with the current guidelines, we emphasize the importance of tailored surgical approaches in penile cancer management. PP's association with fewer complications highlights its potential for favorable patient outcomes when appropriate, and further research is necessary to continue optimizing patient outcomes and management protocols.

Written by: David A. Velasquez,¹ Senthooran Kalidoss,¹ Omer Raheem²

Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
Glickman Urology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE

References:

Velasquez DA, Liu A, Kalidoss S, Yeaman C, Bryk D, Fustok JN, Shelton TM, Alhameedi H, Payakachat N, Kamel M, Ledesma BR, Khalil MI, Smith R, Raheem O. Comparative outcomes of partial versus total penectomy for penile carcinoma: A retrospective cohort study on demographics and postoperative complications. Int J Impot Res. 2024 Jun 18. doi: 10.1038/s41443-024-00935-1. Epub ahead of print. PMID: 38890514.
O'Neill S, Barns M, Vujovic F, Lozinskiy M. The role of penectomy in penile cancer-evolving paradigms. Transl Androl Urol. 2020 Dec;9(6):3191-3194. doi: 10.21037/tau.2019.08.14. PMID: 33457290; PMCID: PMC7807362.
Sood A, Rudzinski JK, Spiess PE, Pettaway CA. The Acute Complications After Surgery for Penile Carcinoma and Strategies for Their Management: A Systematic Review of the Literature. Semin Oncol Nurs. 2022 Jun;38(3):151285. doi: 10.1016/j.soncn.2022.151285. Epub 2022 May 18. PMID: 3559773
Brouwer OR, Albersen M, Parnham A, et al: Penile cancer: European Association of Urology–American Society of Clinical Oncology Collaborative Guidelines on Penile Cancer: 2023 update. Eur Urol. March 9, 2023

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