Impact of the Standardization of Penile Cancer Care on the Quality of Care, Outcomes, and Academic-driven Centralization in a Single eUROGEN Referral Center

Partial penectomy with reconstruction using a split-thickness skin graft: a multicenter experience

BACKGROUND

Penile cancer is a relatively rare neoplasm in developed countries, with the majority of newly diagnosed cases presenting as organ-confined, with a 5-year survival rate of 90%. Therefore, it is crucial to consider the impact of penile tumor resection on sexual and urinary function. Regrettably, the literature is devoid of comprehensive, step-by-step video instructions for the surgical procedure of partial penectomy with reconstruction using a split-thickness skin graft (0.3 mm). This study aimed to demonstrate a step-by-step video of the partial penectomy technique with reconstruction using a split-thickness skin graft and to present the outcomes of this procedure.

METHODS

This multicenter study was initiated in April 2019 and completed in February 2023, enrolling 54 male patients who underwent partial penectomy and reconstruction using a split-thickness skin graft (0.3 mm). The study collected data on the local recurrence rates, overall survival, sexual and voiding functions and complications.

RESULTS

The average patient age was 61.26 years old (range: 26-82 years). Following penile-sparing surgery, a substantial proportion of patients exhibited favorable results. Among the 54 patients, 37 (68.5%) were classified as sexually active and 50 (92.6%) demonstrated good voiding function. Excellent cosmetic outcomes were achieved in 52 patients (96.3%), and the average size of the negative resection margins was 4.75±4.162 mm (range: 0.5 to 20 mm). Notably, no positive margins were observed. Patient outcomes depend on the tumor stage and histologic grade rather than the size of the surgical margin.

CONCLUSIONS

Partial penectomy with reconstruction using a split-thickness skin graft has excellent oncological, functional, and cosmetic outcomes.

Demographic analysis of penectomies in France from 2019 to 2022

INTRODUCTION

Penectomy, whether partial (PP) or radical (RP), are mainly performed for oncological reason. It is a rare but impactful surgery, with significant bio-psycho-social consequences. As some countries moves towards centralization to improve patient outcomes, a demographic analysis of current management in France is needed. This study provides a demographic analysis of partial and total penectomies performed in France from 2019 to 2022.

METHODS

All 2150 total and partial penectomies performed in French healthcare facilities from 2019 to 2022 were included. Data were extracted from Visuchir, an Assurance Maladie data-visualization tool.

RESULTS

Incidence and ratio are stable, around 100 RP and 400 PP per year. The median age of patients was 78. Half of all penectomies were performed in private facilities (n=1115, 51.9%), with a higher rate of PP in these centers (55%, P<0.05). The rate of RP was significantly higher in comorbid patients than the fitter ones. In total, 423 centers reported at least one penectomy over the period, with significant variations in volume. In total, 251 facilities performed less than one procedure per year (59%), while larger centers performed up to 85 over the 4-year period. Length of stay was significantly shorter in high-volume centers.

CONCLUSION

This study shows the heterogeneous distribution and management of penectomies in France. Although there is no official centralization, the data reveal a "reference center" trend. Further data could help determine whether management in high-volume centers improves survival and quality of care for patients requiring penectomy.

LEVEL OF EVIDENCE: 2

Robot-assisted video-endoscopic inguinal lymphadenectomy with the Hugo™ RAS System: surgical set-up and initial experience

BACKGROUND

The Hugo™ RAS system is gaining prominence in the field of urologic robotic surgery. To date, no study has described robot-assisted video-endoscopic inguinal lymphadenectomy (RAVEIL) using this system. Therefore, the aim of the study is to evaluate the feasibility and safety of the procedure, focusing on surgical set-up and preliminary results.

METHODS

A total of seven procedures in five patients with penile cancer were prospectively included. Baseline patient characteristics, intra- and post-operative surgical outcomes were recorded.

RESULTS

Overall, four patients (80%) had negative clinical N-staging (cN0). Median (IQR) operative time was 90 (85-97.5) minutes, with a median (IQR) of 8 (8-9) lymph node yield per procedure. One post-operative complication, a lymphocele requiring percutaneous drainage (Clavien-Dindo 3a), was reported. Median (IQR) hospital stay was 3 (3-3.5) days and the median (IQR) time to drain removal was 8 (6.5-10) days.

CONCLUSIONS

This is the first case series demonstrating the safety and feasibility of RAVEIL using the Hugo™ RAS system. The surgical configuration described may serve as a valuable reference standard for RAVEIL with this robotic platform and help novel adopters in implementing the platform in another surgical scenario.

Complex Decision Making for Individual Patients With Penile Cancer: Benchmarking Divergent Practices in European High-Volume Reference Centers: Results From eUROGEN Survey

BACKGROUND AND OBJECTIVES

Penile cancer (PeCa) remains a challenge due to its rarity and the lack of prospective studies, leading to treatment challenges and controversies. Guidelines offer recommendations, but discrepancies with clinical practice persist. This study analyzed treatment practices among specialists managing high-risk PeCa in European reference centers.

METHODS

A cross-sectional survey included 39 PeCa specialists from 13 European countries representing high-volume centers. Descriptive analysis assessed (neo)adjuvant therapy preferences, systemic regimen choices, immunotherapy use, and next-generation sequencing (NGS) integration.

KEY FINDINGS AND LIMITATIONS

Variations in managing high-risk PeCa, especially in (neo)adjuvant therapy utilization, were noted among participants. The differences highlight the influence of professional backgrounds and variations in treatment approaches between participants. Systemic regimen preferences and immunotherapy utilization also varied. Limited NGS integration indicated gaps in precision medicine adoption. Limitations included sample size, self-reported data, and cross-sectional design.

CONCLUSIONS AND CLINICAL IMPLICATIONS

This study offered insights into PeCa management by specialists in high-volume European reference centers, stressing the need for evidence-based recommendations, guideline adherence, and collaboration to enhance PeCa care.

PATIENT SUMMARY

Managing PeCa is complex due to its rarity and treatment controversies. This study examined practices among specialists in European reference centers, revealing treatment variations. The findings emphasize the importance of evidence-based care and collaboration in optimizing PeCa management.

Follow Up Care After Penile Sparing Surgery for Penile Cancer: Current Perspectives

Penile cancer (PeCa) is a rare urologic tumor worldwide. In 2024, 2100 new cases and 500 deaths are estimated in the United States. Radical surgery via total penectomy has historically been the cornerstone of treatment, since it provides excellent long-term oncological control. The rationale of surgery for penile cancer was to achieve a 2 cm macroscopic surgical margin that is historically advocated to reduce recurrences. Over time, numerous studies have demonstrated that resection margin status does not affect patients' survival. Different penile-sparing techniques are currently recommended in the European Association of Urology-American Society of Clinical Oncology (EAU-ASCO) guidelines for the treatment of localized primary PeCa. Centralization of care could yield multiple benefits, including improved disease awareness, higher rates of penile-sparing surgery, enhanced detection rates, increased utilization of less invasive lymph node staging techniques, enhanced quality of specialized histopathological examinations, and the establishment of specialized multidisciplinary teams. Compared to more aggressive treatments, the higher recurrence rates after penile-sparing surgery do not hamper neither the metastasis-free survival nor the overall survival. Repeated penile-sparing surgery could be considered for selected cases. The psychological impact of penile cancer is not negligible since the perceived loss of masculinity might adversely affect mental health and overall well-being. Quality of life may be compromised by sexual and urinary dysfunction which may be the result either of the loss of penile tissue or the psychological status of the patient. It is of utmost importance to offer rehabilitative treatment as sexual therapy, physical therapy, occupational therapy, family and peer counseling.

Epidemiology of penile cancer in Poland compared to other European countries

OBJECTIVES

To examine the epidemiology of penile cancer in Poland compared to other European countries.

MATERIALS AND METHODS

Incidence and mortality data were acquired from the national cancer registries in Europe and WHO Mortality Database, respectively. The data are presented as age-standardised morbidity and mortality rates, calculated according to the standard population of the world. We utilised Joinpoint analysis to assess the trends in morbidity and mortality and calculated the average rate of increase or decrease (Annual Percentage Change, Average Annual Percentage Change). Additionally, we estimate the proxy survival rates for each country.

RESULTS

Our study is the first to cover the incidence of penile cancer in many European countries and estimates an approximate survival rate for large populations, which is rarely cited in the literature. The 40+ age group presented graphically in the article covered more than 90% of penile cancer cases and deaths. In the countries examined, there was an excess of deaths over incidence in the oldest age groups (75 years or older). Poland had intermediate incidence and mortality rates.

CONCLUSIONS

Unlike many European countries, Poland is witnessing an increasing trend of penile cancer mortality. The higher death toll among those aged 75 years or older may suggest a lack of recognition of cancer symptoms and inadequate attention to elderly patients by the healthcare system. There is also evidence of underreporting penile cancer cases. Establishing centralised healthcare systems for rare cancers is a commendable development that should be emulated by other European countries, including Poland.

[Role of nurses specializing in oncology to support the care journey for patients with penile cancer]

The role of the specialized nurse in the management of penile cancer is essential to ensure quality care and appropriate support throughout the care pathway. Prior knowledge of the pathology seems essential to us. Organization, communication and education are essential to supporting patients. LEVEL OF EVIDENCE: 3.