Serviço de Urologia, Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil.
Departamento de Urologia, Instituto Nacional de Câncer - INCA , Rio de Janeiro, RJ, Brasil.
Int Braz J Urol. 2021 Nov-Dec;47(6):1162-1175. doi: 10.1590/S1677-5538.IBJU.2021.0169.
To evaluate surgical complications and oncological outcomes of patients submitted to primary radical inguinal surgical debulking (PRISD) and myocutaneous pediculate flap reconstruction (MPFR) for locally advanced penile cancer (PC).
Forty-two patients with ulcerated and/or fixed bulky inguinal masses underwent unilateral or bilateral PRISD with MPFR. Tensor fascia lata flap (TFL) was the standard of care for all patients. Additional use of the gracilis flap (GF) was carried out when necessary. Contra-lateral radical inguinal lymphadenectomy (RIL) was conduced when PRISD was performed unilaterally. Surgical complications were analyzed and stratified into minor and major according to the Bevan-Thomas classification. Adjunctive treatments were assessed and oncological outcomes analyzed.
Of the 42 patients evaluated, 10 (23.8%) underwent bilateral PRISD and 32 (76.2%) unilateral PRISD with contra-lateral RIL, totaling 84 lymphadenectomies. A total of 62 MPFRs were performed, 52 with TFL and 10 with GF. A total of 53 complications were identified, 49 related to PRISD with MPFR and 4 to RIL. Adjuvant chemotherapy was carried out in 16 patients. Median follow-up was 10.8 months with a median overall survival (OS) of 14.0 months against 6.0 months (p=0.006) for patients submitted to PRISD with adjuvant chemotherapy in relation to surgery alone.
PRISD alone for advanced loco-regional PC is unlikely to promote long-term survival, although it can lead to temporary local control of the disease. Despite the feasibility of the procedure, it is related to high incidence of complications. Surgical treatment with adjuvant chemotherapy is associated with improved OS.
评估局部晚期阴茎癌（PC）患者行原发性根治性腹股沟外科减瘤术（PRISD）和带蒂肌皮瓣重建（MPFR）的手术并发症和肿瘤学结果。
42 例腹股沟有溃疡和/或固定肿块的患者接受了单侧或双侧 PRISD 联合 MPFR。所有患者均采用阔筋膜张肌皮瓣（TFL）作为标准治疗。当需要时，可额外使用股薄肌皮瓣（GF）。当单侧 PRISD 时，行对侧根治性腹股沟淋巴结切除术（RIL）。根据 Bevan-Thomas 分类法分析并分层手术并发症为轻微和严重。评估辅助治疗和肿瘤学结果。
在 42 例患者中，10 例（23.8%）行双侧 PRISD，32 例（76.2%）行单侧 PRISD 联合对侧 RIL，共计 84 例淋巴结清扫术。共进行了 62 例 MPFR，其中 52 例采用 TFL，10 例采用 GF。共发现 53 例并发症，其中 49 例与 PRISD 联合 MPFR 相关，4 例与 RIL 相关。16 例患者接受辅助化疗。中位随访时间为 10.8 个月，接受 PRISD 联合辅助化疗的患者中位总生存期（OS）为 14.0 个月，而仅接受手术的患者为 6.0 个月（p=0.006）。
对于局部晚期 PC，单独行 PRISD 不太可能促进长期生存，尽管它可以暂时控制疾病的局部进展。尽管该手术可行，但它与高并发症发生率相关。联合辅助化疗的手术治疗与改善 OS 相关。
