Hussain M Alnajjar1, Findlay MacAskill1, Michelle Christodoulidou1, Ash Mosahebi2, Clare Akers1, Raj Nigam1, Peter Malone1, David Ralph1, Anita Mitra3, Asif Muneer1,4,5. 1. Department of Urology, University College London Hospitals NHS Trust, London, UK. 2. Department of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, London, UK. 3. Department of Oncology, University College London Hospitals NHS Trust, London, UK. 4. NIHR Biomedical Research Centre University College London Hospitals, London, UK. 5. Division of Surgery and Interventional Science, UCL, London, UK.
Abstract
BACKGROUND: Penile cancer patients with advanced metastatic disease in the inguinal region present a therapeutic challenge. We compared the outcomes for patients with advanced inguinal node disease requiring myocutaneous flap reconstruction (MFR) against primary closure for N3 disease. METHODS: A retrospective comparative study of a consecutive cohort of advanced penile cancer patients with N3 disease was performed. Patient demographics, presenting symptoms, primary tumour site, stage and grade were recorded. The type of MFR used, patient outcomes and post-operative complications were recorded from an institutional database. Kaplan-Meier (KM) curves were calculated to analyse the cancer-specific survival (CSS) rates for the MFR group and compared with the no-MFR group. P values were calculated by log-rank and Chi square tests for CSS rates and complications respectively. RESULTS: Eighteen patients requiring MFR were identified; mean age 62 years. Ten (55.6%) patients had a first presentation with penile cancer and advanced nodal disease with the remaining 8 (44.4%) presenting with an inguinal recurrence having already undergone surgery. The majority (n=15) underwent a vertical rectus abdominis myocutaneous (VRAM) flap. The average length of stay was 23 days for the MFR group versus 8.5 days for the no-MFR group. The 5-year CSS was 20.9% for the MFR group and 39.8% for the no-MFR group (P<0.01). CONCLUSIONS: Aggressive surgical management for patients with extensive nodal disease and flap reconstruction is feasible and aids wound management although the long-term prognosis is still poor.
BACKGROUND: Penile cancer patients with advanced metastatic disease in the inguinal region present a therapeutic challenge. We compared the outcomes for patients with advanced inguinal node disease requiring myocutaneous flap reconstruction (MFR) against primary closure for N3 disease. METHODS: A retrospective comparative study of a consecutive cohort of advanced penile cancer patients with N3 disease was performed. Patient demographics, presenting symptoms, primary tumour site, stage and grade were recorded. The type of MFR used, patient outcomes and post-operative complications were recorded from an institutional database. Kaplan-Meier (KM) curves were calculated to analyse the cancer-specific survival (CSS) rates for the MFR group and compared with the no-MFR group. P values were calculated by log-rank and Chi square tests for CSS rates and complications respectively. RESULTS: Eighteen patients requiring MFR were identified; mean age 62 years. Ten (55.6%) patients had a first presentation with penile cancer and advanced nodal disease with the remaining 8 (44.4%) presenting with an inguinal recurrence having already undergone surgery. The majority (n=15) underwent a vertical rectus abdominis myocutaneous (VRAM) flap. The average length of stay was 23 days for the MFR group versus 8.5 days for the no-MFR group. The 5-year CSS was 20.9% for the MFR group and 39.8% for the no-MFR group (P<0.01). CONCLUSIONS: Aggressive surgical management for patients with extensive nodal disease and flap reconstruction is feasible and aids wound management although the long-term prognosis is still poor.
Entities:
Keywords:
Advanced N3 disease; myocutaneous flap; penile cancer; tensor fascia lata (TFL); vertical rectus abdominis myocutaneous (VRAM)
Authors: Yuko Smith; Paul Hadway; Olaf Biedrzycki; Matthew J A Perry; Catherine Corbishley; Nicholas A Watkin Journal: Eur Urol Date: 2007-02-20 Impact factor: 20.096