Development of minimally invasive approaches in penile cancer

Introduction: Penile cancer (PeCa) is a rare genital malignancy. The prognosis for patients presenting early and with no involvement of the inguinal lymph nodes is excellent. Advances in penile preserving surgery and avoiding overtreatment of inguinal lymph nodes aims to reduce the morbidity of surgery. The aim of this thesis is to investigate penile cancer surgical techniques to reduce morbidity.

Methods: A total of 10 peer-reviewed research papers (as senior author) were critically evaluated. These included surgical treatment for primary disease which described novel techniques and predictors for local recurrence using a consecutive cohort of patients for data analysis. The outcomes from dynamic sentinel lymph node biopsy and the management of non-visualisation were evaluated using a complete dataset of patients with impalpable inguinal lymph nodes. Finally, the management of inguinal lymph nodes using a fascial sparing technique used a data set from 2 specialist centres and combined the data to report on the surgical outcomes.

Results: The results from the studies included in this thesis show that with penile preserving procedures such as glansectomy, the local recurrence rate is less than 10%. The results from the dynamic sentinel lymph node studies showed that a delayed procedure was feasible with a sensitivity of 88.9%. The non-visualisation group can be visualised on repeat dynamic sentinel node biopsy in 86% of cases. The complication rate of fascial sparing inguinal lymphadenectomy is 36.1% and lower than previously reported series. The use of novel techniques such as “Batman’ scrotectomy and myocutaneous flaps is associated with low wound complications and allows palliation of patients.

Discussion: The management of penile cancer has undergone significant change over the study period. The use of minimally invasive surgery has reduced morbidity and not significantly impacted on the local recurrence rate or cancer specific survival.