Carcinoma of the penis: experience from 360 cases

To report the therapeutic results of 360 cases of squamous cell carcinoma of the penis treated by surgery.

During the period 1974-1993 the records of 360 patients admitted in our Department with histologically diagnosed squamous cell penile cancer were retrospectively analyzed. Eighty-eight percent of them were uncircumcised. The surgical treatment which was performed included: circumcision 32 patients, local excision 12, partial amputation 227, total amputation 75, and 5 cystostomies in 5 of the 9 inoperable patients. Eightytwo patients had metastases to the inguinal lymph nodes; 30 inguinal,4 ilio-inguinal unilateral, and 35 inguinal,13 ilio-inguinal bilateral lymph node dissections were performed. In cases with partial amputation 1.5 cm margin proximal to the tumor was left.

No local recurrence after partial or total amputation occurred. In 19 (8%) patients with partial amputation and in 5 (7%) with total amputation urethral meatus stenosis appeared. Complications after lymphadenectomy were as follows: wound infection in 12 (10%) patients, skin flap necrosis in 14 (12%), lymphocele in 17 (14%) and lymphedema in 19 (16%; 4 unilateral and15 bilateral). The 5-year survival was 91% for patients with stage T1-3 N0, 59% for patients with stage T1- 3 N1-2 and 29% for patients with stage T1-3 N3. At 10 years the survival was 80%, 42% and 0%, respectively.

As the stage at presentation appears to be the most important prognostic variable for survival, early diagnosis and treatment give the best results. In stage T3 it is better to do primary lymphadenectomy as the possibility for metastasis during 2-3 years after amputation is about 80%. In stage T2 with poorly differentiated tumors, if the patient is not suitable for surveillance, it is also better to do primary lymphadenectomy as the possibility for metastases is about 30%.