Penile cancer: significance of positive surgical margins in organ-sparing surgery
Wednesday, 31 March 2010- Organ-sparing surgery in the treatment of penile cancer (SCC) requires a compromise between preservation of function and acceptable cosmetic appearance with the need for local cancer control.
S. Ivaz and colleagues (London, UK) conducted a study to determine the significance of a positive invasive surgical margin after penile-preserving surgery, and to identify appropriate management strategies in such patients. They presented their findings at the ASCO 2010 Genitourinary Cancers Symposium held in San Francisco, California, USA.
A retrospective analysis was conducted of patients who underwent organ-preserving surgery for treatment of SCC penis with positive invasive margins in a single supra-regional centre between 2001 and 2008.
All specimens were reviewed by a specialist histopathologist. Patients either underwent early surgical re-resection, or were placed under active surveillance after agreement at the multidisciplinary meeting.
Criteria for early re- resection included extensive contiguous deep positive margin or non-healing graft site within 3 months. Patients who underwent surgery of non-curative intention, or those who received adjuvant therapies were excluded.
The results showed that 40 out of 325 penile preserving procedures were identified to have an invasive positive margin (follow-up 12-84 months). A total of 30 patients had early re-resection, of whom 17 (56.7%) had residual disease and 13 had no disease. Six patients required further resections (between 1-3 re-resections) before being rendered disease free. For patients on surveillance, 1 had confirmed recurrence (10%) and 9 remain recurrence free.
"Focal positive margins have a low rate of recurrence in our series and could be observed initially if there is no visible abnormality. The recurrence rate for more extensive margins justifies early re-resection," the researchers concluded.
Source: S. Ivaz, et al., "Significance of positive surgical margins in organ-sparing surgery for invasive squamous carcinoma of the penis," Abstract 253, ASCO 2010 Genitourinary Cancers Symposium, San Francisco, California, USA.