Comparison of wide local excision and radical excision for Paget’s disease involving the penis and scrotum_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MENG Fanjun , PU Yi , CHEN Zhixing ,  CEN Ying ,  CHEN Junjie

Department of Burns and Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

CEN Ying, Email: Cenying0141@163.com; CHEN Junjie, Email: cjjemail@163.com

Keywords：

Paget’s disease involving penis and scrotum; wide local excision; radical resection; recurrence rate

DOI：

10.7507/1002-1892.201701070

Video：

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Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ²=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.

Citation： MENG Fanjun, PU Yi, CHEN Zhixing, CEN Ying, CHEN Junjie. Comparison of wide local excision and radical excision for Paget’s disease involving the penis and scrotum. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 714-717. doi: 10.7507/1002-1892.201701070 Copy

1.	Black D, Tornos C, Soslow RA, et al. The outcomes of patients with positive margins after excision for intraepithelial Paget’s disease of the vulva. Gynecologic Oncology, 2007, 104(3): 547-550.
2.	Jeon MS, Jung GY, Lee JH, et al. Extramammary Paget disease of the vulva: minimal excision with adjuvant radiation treatment for optimal aesthetic results. Tumori, 2016, 102(Suppl 2): doi: 10.5301/tj.5000394.
3.	Lee KY, Roh MR, Chung WG, et al. Comparison of Mohs micrographic surgery and wide excision for extramammary Paget’s disease: Korean experience. Dermatol Surg, 2008, 35(1):34-40.
4.	刘颖, 张新华, 余波,等. 30 例乳腺外 Paget 病的临床病理及预后分析. 临床与实验病理学杂志, 2014, 30(11): 1211-1214.
5.	Kang Z, Zhang Q, Zhang Q, et al. Clinical and pathological characteristics of extramammary Paget’s disease: report of 246 Chinese male patients. Int J Clin Exp Pathol, 2015, 8(10): 13233-13240.
6.	Hatta N, Yamada M, Hirano T, et al. Extramammary Paget’s disease: treatment, prognostic factors and outcome in 76 patients. Br J Dermatol, 2008, 158(2): 313-318.
7.	Shiomi T, Yoshida Y, Yamamoto O, et al. Original paper Extramammary Paget’s disease: evaluation of the adnexal status of 53 cases. Polish Journal of Pathology, 2015, 66(2): 121-126.
8.	Cohen JM, Granter SR, Werchniak AE. Risk stratification in extramammary Paget disease. Clin Exp Dermatol, 2015, 40(5): 473-478.
9.	Ogata D, Kiyohara Y, Yoshikawa S, et al. Usefulness of sentinel lymph node biopsy for prognostic prediction in extramammary Paget’s disease. Eur J Dermatol, 2016, 26(3): 254-259.
10.	Fujisawa Y, Yoshino K, Kiyohara Y, et al. The role of sentinel lymph node biopsy in the management of invasive extramammary Paget’s disease: Multi-center, retrospective study of 151 patients. J Dermatol Sci, 2015, 79(1): 38-42.
11.	郭亮侬, 刘小青, 李航,等. 乳房外 Paget 病 75 例临床病理特点分析. 中华医学杂志, 2015, 95(22): 1751-1754.
12.	Murata T, Honda T, Egawa G, et al. Three-dimensional evaluation of subclinical extension of extramammary Paget’s disease: Visualization of histological border and its comparison to clinical border. Br J Dermatol, 2016. [Epub ahead of print].
13.	Shiomi T, Yoshida Y, Shomori K, et al. Extramammary Paget’s disease: evaluation of the histopathological patterns of Paget cell proliferation in the epidermis. J Dermatol, 2011, 38(11): 1054-1057.
14.	Herrel LA, Weiss AD, Goodman M, et al. Extramammary Paget’s disease in males: survival outcomes in 495 patients. Ann Surg Oncol, 2015, 22(5): 1625-1630.
15.	刘斌, 于东风, 常家聪, 等. 高龄贲门癌患者的临床特点及外科治疗的探讨. 中华普通外科杂志, 2002, 17(8): 461-462.
16.	赵平, 唐令超, 丁志, 等. 超高龄与其他年龄组胃癌患者手术治疗的对比分析. 中国肿瘤临床与康复, 2013, 20(2): 128-130.
17.	史继荣, 刘斯, 赵建勋. 75 岁以上高龄患者的外科决策——附 133 例病例报告. 中国现代医学杂志, 2007, 17(15): 1853-1855.
18.	卿勇, 岑瑛, 刘晓雪, 等. 会阴部 Paget’s 病的外科治疗. 中国修复重建外科杂志, 2007, 21(11): 1213-1215.

1. Black D, Tornos C, Soslow RA, et al. The outcomes of patients with positive margins after excision for intraepithelial Paget’s disease of the vulva. Gynecologic Oncology, 2007, 104(3): 547-550.
2. Jeon MS, Jung GY, Lee JH, et al. Extramammary Paget disease of the vulva: minimal excision with adjuvant radiation treatment for optimal aesthetic results. Tumori, 2016, 102(Suppl 2): doi: 10.5301/tj.5000394.
3. Lee KY, Roh MR, Chung WG, et al. Comparison of Mohs micrographic surgery and wide excision for extramammary Paget’s disease: Korean experience. Dermatol Surg, 2008, 35(1):34-40.
4. 刘颖, 张新华, 余波,等. 30 例乳腺外 Paget 病的临床病理及预后分析. 临床与实验病理学杂志, 2014, 30(11): 1211-1214.
5. Kang Z, Zhang Q, Zhang Q, et al. Clinical and pathological characteristics of extramammary Paget’s disease: report of 246 Chinese male patients. Int J Clin Exp Pathol, 2015, 8(10): 13233-13240.
6. Hatta N, Yamada M, Hirano T, et al. Extramammary Paget’s disease: treatment, prognostic factors and outcome in 76 patients. Br J Dermatol, 2008, 158(2): 313-318.
7. Shiomi T, Yoshida Y, Yamamoto O, et al. Original paper Extramammary Paget’s disease: evaluation of the adnexal status of 53 cases. Polish Journal of Pathology, 2015, 66(2): 121-126.
8. Cohen JM, Granter SR, Werchniak AE. Risk stratification in extramammary Paget disease. Clin Exp Dermatol, 2015, 40(5): 473-478.
9. Ogata D, Kiyohara Y, Yoshikawa S, et al. Usefulness of sentinel lymph node biopsy for prognostic prediction in extramammary Paget’s disease. Eur J Dermatol, 2016, 26(3): 254-259.
10. Fujisawa Y, Yoshino K, Kiyohara Y, et al. The role of sentinel lymph node biopsy in the management of invasive extramammary Paget’s disease: Multi-center, retrospective study of 151 patients. J Dermatol Sci, 2015, 79(1): 38-42.
11. 郭亮侬, 刘小青, 李航,等. 乳房外 Paget 病 75 例临床病理特点分析. 中华医学杂志, 2015, 95(22): 1751-1754.
12. Murata T, Honda T, Egawa G, et al. Three-dimensional evaluation of subclinical extension of extramammary Paget’s disease: Visualization of histological border and its comparison to clinical border. Br J Dermatol, 2016. [Epub ahead of print].
13. Shiomi T, Yoshida Y, Shomori K, et al. Extramammary Paget’s disease: evaluation of the histopathological patterns of Paget cell proliferation in the epidermis. J Dermatol, 2011, 38(11): 1054-1057.
14. Herrel LA, Weiss AD, Goodman M, et al. Extramammary Paget’s disease in males: survival outcomes in 495 patients. Ann Surg Oncol, 2015, 22(5): 1625-1630.
15. 刘斌, 于东风, 常家聪, 等. 高龄贲门癌患者的临床特点及外科治疗的探讨. 中华普通外科杂志, 2002, 17(8): 461-462.
16. 赵平, 唐令超, 丁志, 等. 超高龄与其他年龄组胃癌患者手术治疗的对比分析. 中国肿瘤临床与康复, 2013, 20(2): 128-130.
17. 史继荣, 刘斯, 赵建勋. 75 岁以上高龄患者的外科决策——附 133 例病例报告. 中国现代医学杂志, 2007, 17(15): 1853-1855.
18. 卿勇, 岑瑛, 刘晓雪, 等. 会阴部 Paget’s 病的外科治疗. 中国修复重建外科杂志, 2007, 21(11): 1213-1215.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of wide local excision and radical excision for Paget’s disease involving the penis and scrotum

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