Partial penectomy reduces complications, procedures in penile cancer

Following a penile cancer diagnosis, partial penectomy can be associated with fewer postoperative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures, compared with total penectomy, according to a presentation at the 24th Annual Fall Scientific Meeting of Sexual Medicine Society of North America.¹

“Ultimately, total penectomy is associated with a higher proportion of patients suffering from chronic comorbid conditions, likely due to their higher disease burden that causes a person's decision in the first place,” said Senthooran Kalidoss, University of Chicago. “Partial penectomy is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures.”

In the United States, approximately 2200 new cases of penile cancer are diagnosed each year, according to Senthooran Kalidoss, University of Chicago, with a higher prevalence in developing countries. “The majority are due to HPV infections which lead to squamous cell carcinoma,” he added. “There is an overall 67% 5-year survival rate, which decreases precipitously for patients with metastatic disease to about 12%. And the surgical treatments for squamous cell carcinoma are always challenging due to psychological, sexual, and erectile complications.”

As a result, partial penectomies are performed more frequently for preservation; however, because of the disease’s rarity, penile cancer research is mostly limited to single-center, retrospective reviews, “which come with their limitations,” Kalidoss said.

The investigators conducted a retrospective review of 260 patients with penile cancer from the National Surgical Quality Improvement Program over a 6-year span to compare partial vs total penectomy across various parameters to assess the differences in pre-operative risk factors and post-operative complications. They assessed demographics, clinical characteristics, postoperative outcomes, and current procedures.

In total, 67 patients underwent total penectomy and 193 had partial penectomy in the retrospective review.

In the overall population, patients were a mean age of 70.90 years, had a white blood cell count of 8.49 x 109 per liter, hematocrit of 39.49%, and 29.6% had diabetes mellitus.

According to the abstract, patients who underwent partial penectomy were less likely to be transferred patients (7.3% vs 20.9%, respectively; P = .002), less likely to be suffering from diabetes (25.9% vs 40.3%; P = .026), and were more likely to have preoperative laboratory values within normal limits. Further, patients who had total penectomy were more likely to have a higher preoperative white blood cell count (P < .001) and a lower preoperative hematocrit percentage (P < .001), while those who underwent partial penectomy had higher pre-operative creatinine levels (P = .037) and lower platelet levels (P = .045).

Those who underwent partial penectomy experienced shorter inpatient stay lengths, compared with total penectomy (mean, 1.67 vs 4.31 days, respectively; P < .001), quicker operation times (mean, 78.82 minutes vs 145.50; P < .001), and a lower rate of 30-day post-surgery complication (7.2% vs 31.3%; P < .001).

When evaluating complications, those who had partial, vs total, penectomy experienced less instances of superficial incisional surgical site infection (4 vs 5, respectively), deep incisional surgical infection (0 vs 3), organ space surgical site infection (0 vs 2), and wound disruption (1 vs 4). Further, according to the abstract, fewer patients with partial penectomy also reported with sepsis (0.5% vs 7.5%, respectively; P = .005).

Lastly, patients who had total penectomy had a significantly greater number of concurrent surgical procedures (P < .001).

The study authors noted that there was no information to report on urinary, sexual, and erectile outcomes in the database used for the retrospective review.

“Ultimately, total penectomy is associated with a higher proportion of patients suffering from chronic comorbid conditions, likely due to their higher disease burden that causes a person's decision in the first place,” Kalidoss said. “Partial penectomy is associated with fewer post-operative complications, shorter surgeries, shorter hospital stays, and fewer concurrent surgical procedures.”

He added that this is important to know because the number of partial vs total penectomies has increased gradually over time, “which are likely due to better screening and recommendations for this procedure for these patients.”

Kalidoss concluded that these risk factors associated with each procedure are important for clinicians to know about and consider. He also urged clinicians to record their data to help colleagues improve patients’ postoperative sexual function and record total or partial penectomy at a national level across institutions.

“Essentially it's important for us to do a better job at collecting this data so that we're able to consider patients’ sexual erectile problems as well as performing these procedures and the big questions [that remain to be answered].”

Reference

1. Liu A, Yeaman C, Bryk D, et al. Comparing Postoperative Outcomes and Risk Factors for Patients Undergoing Partial vs Total Penectomy for Penile Carcinoma. Presented at: 24th Annual Fall Scientific Meeting SMSNA; November 16-18, 2023; San Diego, CA. Abstract 20.