Phallus preservation and reconstruction: 5-year outcomes of national penile cancer centralisation in the Republic of Ireland

Donnacha Hogan; Sarah M Norton; Kenneth Patterson; Adrian Murphy; Brian O'Neill; Padraig Daly; Ivor M Cullen

doi:10.1016/j.surge.2024.04.002

Phallus preservation and reconstruction: 5-year outcomes of national penile cancer centralisation in the Republic of Ireland

Surgeon. 2024 Apr 13:S1479-666X(24)00033-7. doi: 10.1016/j.surge.2024.04.002. Online ahead of print.

Authors

Donnacha Hogan¹, Sarah M Norton², Kenneth Patterson², Adrian Murphy³, Brian O'Neill⁴, Padraig Daly⁵, Ivor M Cullen⁶

Affiliations

¹ Department of Urology, Beaumont Hospital, Dublin, Ireland. Electronic address: Donnacha.hogan@umail.ucc.ie.
² Department of Urology, Beaumont Hospital, Dublin, Ireland.
³ Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
⁴ Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland.
⁵ Department of Urology, University Hospital Waterford, Waterford, Ireland.
⁶ Department of Urology, Beaumont Hospital, Dublin, Ireland; National Cancer Control Programme, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.

PMID: 38614838
DOI: 10.1016/j.surge.2024.04.002

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.

Keywords: Centralisation; Organ preservation; Outcomes; Penile cancer; Phallus preservation.