Minhas Suks, Kayes Oliver, Hegarty Paul, Kumar Pardeep, Freeman Alex, Ralph David
Institute of Urology and Nephrology, University College London, Riding Housr Street, London, UK.
BJU Int. 2005 Nov;96(7):1040-3. doi: 10.1111/j.1464-410X.2005.05769.x.
To evaluate the surgical excision margin required for local oncological control in primary penile cancers, as patients with penile cancer who undergo radical amputation suffer marked psychological, functional and cosmetic sequelae, and although organ-sparing surgery has improved the quality of life of these men, the optimum surgical excision margin to achieve oncological control is unknown.
In all, 51 patients (mean age 61 years) diagnosed with squamous cell carcinoma of the penis between May 2000 and December 2004 were selected for treatment with conservative surgical techniques. All patients were staged before surgery using magnetic resonance imaging. Histopathological features of the tumours, including type, grade, stage and distance from the surgical excision margin, were evaluated. All patients were followed in the outpatient department according to European Association of Urology guidelines.
The median (range) follow-up of the men was 26 (2-55) months. Patients were treated by wide localized excision (nine), glans excision (26) and partial penectomy (16). The histopathological review included the analysis of 102 surgical margins (deep and skin) with 49 (48%) measured within 10 mm of the tumour edge and 92 (90%) within a <20-mm resection margin. Three patients (6%) had tumour involvement at the surgical margin and had further surgery. During follow-up two patients (4%) developed local tumour recurrence and were treated successfully with partial penectomy.
A traditional 2-cm excision margin is unnecessary for treating squamous cell carcinoma of the penis. Conservative techniques, involving excision margins of only a few millimetres, appear to offer excellent oncological control.
评估原发性阴茎癌实现局部肿瘤学控制所需的手术切缘，因为接受根治性截肢的阴茎癌患者会遭受明显的心理、功能和美容后遗症，尽管保留器官手术改善了这些男性的生活质量，但实现肿瘤学控制的最佳手术切缘尚不清楚。
2000年5月至2004年12月期间，共选取51例（平均年龄61岁）诊断为阴茎鳞状细胞癌的患者采用保守手术技术治疗。所有患者术前均使用磁共振成像进行分期。评估肿瘤的组织病理学特征，包括类型、分级、分期以及距手术切缘的距离。所有患者均按照欧洲泌尿外科学会指南在门诊进行随访。
男性患者的中位（范围）随访时间为26（2 - 55）个月。患者接受了广泛局部切除（9例）、龟头切除（26例）和部分阴茎切除术（16例）。组织病理学检查包括对102个手术切缘（深部和皮肤）的分析，其中49个（48%）在肿瘤边缘10毫米内测量，92个（90%）在切除边缘<20毫米内。3例患者（6%）手术切缘有肿瘤累及，接受了进一步手术。随访期间，2例患者（4%）出现局部肿瘤复发，经部分阴茎切除术成功治疗。
治疗阴茎鳞状细胞癌无需传统的2厘米切缘。仅几毫米切缘的保守技术似乎能提供良好的肿瘤学控制。
