title: Conservative surgery for squamous cell carcinoma of the penis: resection margins and long-term oncological control.
abstract: OBJECTIVE
  We assessed the oncological outcome of penile conserving surgery and identified parameters predicting local recurrence, including resection margins.
  
  
  METHODS
  A total of 179 patients with invasive penile cancer treated with organ sparing surgery at a tertiary center between 2002 and 2010 fulfilled our study criteria. Demographic, histopathological, management and followup data were recorded in a prospective database. Local, regional and distant recurrence rates, time to recurrence and survival rates were calculated. Survival analysis was performed by the Kaplan-Meier method. Multivariate analysis was used to identify predictors of local recurrence.
  
  
  RESULTS
  Mean followup was 42.8 months (range 4 to 107). Local, regional and distant metastatic recurrence developed in 16 (8.9%), 19 (10.6%) and 9 patients (5.0%) at a mean of 26.1, 26.8 and 11.7 months, respectively. The 5-year disease specific survival rate after recurrence was 54.7% (95% CI 46.1-63.3). For patients with isolated local recurrence the 5-year disease specific survival rate was 91.7% compared to 38.4% for those with regional recurrence. The overall 5-year local recurrence-free rate was 86.3% (95% CI 82.6-90.4). Tumor grade (p = 0.003), stage (p = 0.021) and lymphovascular invasion (p = 0.014) were identified as predictors of local recurrence on multivariate analysis.
  
  
  CONCLUSIONS
  Penile conserving surgery is oncologically safe and a surgical excision margin of less than 5 mm is adequate. Higher local recurrence rates are associated with lymphovascular invasion, and higher tumor stage and grade. Local recurrence has no negative impact on long-term survival.
authors: Department of Andrology, Institute of Urology, University College London Hospitals, London, United Kingdom. brucemed@hotmail.com
authors: Prodromos
authors: P
authors: Philippou
authors: Majid
authors: M
authors: Shabbir
authors: Peter
authors: P
authors: Malone
authors: Raj
authors: R
authors: Nigam
authors: Asif
authors: A
authors: Muneer
authors: David J
authors: DJ
authors: Ralph
authors: Suks
authors: S
authors: Minhas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010412:Penile Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods