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Hogan D, Norton SM, Patterson K, Murphy A, O'Neill B, Daly P, Cullen IM. Phallus preservation and reconstruction: 5-year outcomes of national penile cancer centralisation in the Republic of Ireland. Surgeon 2024:S1479-666X(24)00033-7. [PMID: 38614838 DOI: 10.1016/j.surge.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
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.
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Affiliation(s)
- Donnacha Hogan
- Department of Urology, Beaumont Hospital, Dublin, Ireland.
| | - Sarah M Norton
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | | | - Adrian Murphy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Brian O'Neill
- Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland
| | - Padraig Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Ivor M Cullen
- Department of Urology, Beaumont Hospital, Dublin, Ireland; National Cancer Control Programme, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Anderson S, Breen KJ, Davis NF, Deady S, Sweeney P. Penile cancer in Ireland - A national review. Surgeon 2021; 20:187-193. [PMID: 34034967 DOI: 10.1016/j.surge.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Penile cancer is a rare malignancy, with a reported incidence of 1.5/100,000 males in the Republic of Ireland in 2015. The aim of this study was to perform the first national review and to evaluate clinicopathological factors affecting survival. SUBJECTS AND METHODS All cases of penile cancer in Ireland between 1995 and 2010 were identified through the National Cancer Registry Ireland (NCRI) and analysed to identify factors affecting survival. RESULTS 360 cases of penile cancer were identified, with a mean age at diagnosis of 65.5 years and 88% (n = 315) of cases occurred in those over 50. 91% (n = 328) of cases were squamous cell carcinomas (SCC). The majority of patients were treated surgically (n = 289), with 57% (n = 206) and 24% (n = 87) undergoing partial penectomy and total penectomy respectively. Only 18% (n = 65) received radiotherapy, and 8% (n = 27) received chemotherapy. Mean overall survival (OS) was 113 months, and five year disease specific survival (DSS) was 70% (95%CI: 59.1-77.8%). Age at diagnosis, nodal status and presence of metastatic disease were independent prognostic markers on multivariate analysis. CONCLUSION This study represents the first national review of penile cancer in Ireland. The annual incidence and survival rates are comparable to European figures, though superior DSS has previously been reported from our institution, highlighting the role for centralisation of care in Ireland. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- S Anderson
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland.
| | - K J Breen
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland
| | - N F Davis
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland
| | - S Deady
- National Cancer Registry of Ireland, Ireland
| | - P Sweeney
- Department of Urology, Mercy University Hospital, Co. Cork, Ireland
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Teh J, Duncan C, Qu L, Guerra G, Narasimhan V, Pham T, Lawrentschuk N. Inguinal lymph node dissection for penile cancer: a contemporary review. Transl Androl Urol 2020; 9:3210-3218. [PMID: 33457292 PMCID: PMC7807325 DOI: 10.21037/tau.2019.08.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Penile cancer is an uncommon disease associated with significant psychological and physical morbidity. Penile cancer has an expectable pattern of spread in a stepwise fashion, from inguinal to pelvic lymph nodes (PLN) then distant spread. Patients with penile cancer have variable survival, with patients with a low burden of nodal metastatic disease having lasting survival with surgical management, however patients with a large amount of locoregional metastatic disease having a worse prognosis. The current management options for patients with metastatic lymph node disease in penile cancer aims to reduce the morbidity associated with radical inguinal lymph node (ILN) surgery with appropriate risk stratification to optimise oncological control of the disease. This article describes current challenges in managing the inguinal region in patients with penile squamous cell carcinoma (SCC).
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Affiliation(s)
- Jiasian Teh
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia
| | - Catriona Duncan
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia
| | - Liang Qu
- Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia
| | - Glen Guerra
- Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Toan Pham
- Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
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Williams SB, Ray-Zack MD, Hudgins HK, Oldenburg J, Trinh QD, Nguyen PL, Shore ND, Wirth MP, O'Brien T, Catto JWF. Impact of Centralizing Care for Genitourinary Malignancies to High-volume Providers: A Systematic Review. Eur Urol Oncol 2019; 2:265-273. [PMID: 31200840 PMCID: PMC10007401 DOI: 10.1016/j.euo.2018.10.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT The centralization of cancer care is associated with better clinical outcomes and may be a method for optimizing value-based health care systems. OBJECTIVE To systematically review the literature regarding the impact of centralization of care on clinical outcomes for genitourinary malignancies. EVIDENCE ACQUISITION A systematic review was conducted using Ovid and MEDLINE to identify studies between 1970 and 2018 reporting on the centralization of care for genitourinary malignancies. Prospective and retrospective studies were screened. EVIDENCE SYNTHESIS There were no published randomized control trials (RCTs) on the centralization of care for genitourinary malignancies. Twenty-two retrospective studies met inclusion criteria. Centralization of radical cystectomy was the most studied. Care for bladder cancer, prostate cancer, penile cancer, testicular cancer, and renal cancer was reportedly associated with better morbidity and survival outcomes for patients treated at high-volume centers. However, evidence of better outcomes for centralization of care remains limited for penile, renal, and testicular cancers owing to the paucity of data and/or the lower incidence of these genitourinary malignancies. CONCLUSIONS Care for genitourinary malignancies by high-volume providers was associated with greater utilization of cancer surgery, lower morbidity, and better survival outcomes. Centralization of care was most appropriate for complex procedures such as radical cystectomy when interpreted in the context of survival outcomes. Further research is needed to address the impact of centralizing care for all urologic malignancies with consideration of the associated costs and patient-reported measures, including quality of life and patient experience. PATIENT SUMMARY We explored the evidence for moving major operations into larger centers. We focused on surgery for cancers of the bladder, prostate, testicle, penis, and kidney, and found that larger-volume hospitals had better survival outcomes and fewer complications when compared to smaller hospitals. The difference may be greatest for complex major surgeries such as radical cystectomy.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Mohamed D Ray-Zack
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Hogan K Hudgins
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal D Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Manfred P Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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